| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2387 |
Power wheelchair accessory, foam filled caster tire, any size, replacement only, each |
30 |
13 |
$985.29 |
| E2395 |
Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each |
30 |
13 |
$934.22 |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
31 |
28 |
$682.82 |
| E2210 |
Wheelchair accessory, bearings, any type, replacement only, each |
16 |
13 |
$221.16 |
| K0462 |
Temporary replacement for patient owned equipment being repaired, any type |
28 |
25 |
$48.76 |