| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
688 |
688 |
$43K |
| E2615 |
Pos back post/lat wdth <22in |
15 |
15 |
$764.48 |
| E0955 |
Cushioned headrest |
42 |
42 |
$600.84 |
| E2607 |
Skin pro/pos wc cus wd <22in |
15 |
15 |
$479.85 |
| E0973 |
W/ch access det adj armrest |
16 |
16 |
$440.46 |
| E2231 |
Solid seat support base |
12 |
12 |
$437.93 |
| K0040 |
Adjustable angle footplate |
35 |
19 |
$352.60 |
| E0978 |
W/c acc,saf belt pelv strap |
47 |
47 |
$311.16 |
| E0971 |
Wheelchair anti-tipping devi |
16 |
16 |
$243.57 |
| E0960 |
W/c shoulder harness/straps |
18 |
18 |
$225.37 |
| E1028 |
W/c manual swingaway |
13 |
12 |
$200.77 |
| E2213 |
Pneumatic prop tire insert |
16 |
16 |
$165.69 |
| E0951 |
Loop heel |
14 |
14 |
$63.07 |