| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
4,166 |
3,415 |
$1.10M |
| K0739 |
Repair/svc dme non-oxygen eq |
3,167 |
3,031 |
$232K |
| E1399 |
Durable medical equipment mi |
335 |
250 |
$181K |
| E0240 |
Bath/shower chair |
144 |
144 |
$179K |
| E1028 |
W/c manual swingaway |
1,278 |
1,043 |
$168K |
| E0973 |
W/ch access det adj armrest |
738 |
594 |
$70K |
| E2609 |
Custom fabricate w/c cushion |
83 |
80 |
$64K |
| K0040 |
Adjustable angle footplate |
574 |
487 |
$47K |
| E2617 |
Custom fab w/c back cushion |
60 |
57 |
$42K |
| E0956 |
W/c lateral trunk/hip suppor |
186 |
155 |
$39K |
| K0005 |
Ultralightweight wheelchair |
26 |
25 |
$38K |
| E0971 |
Wheelchair anti-tipping devi |
487 |
393 |
$30K |
| E0955 |
Cushioned headrest |
380 |
369 |
$21K |
| E0960 |
W/c shoulder harness/straps |
367 |
326 |
$21K |
| E1161 |
Manual adult wc w tiltinspac |
66 |
66 |
$14K |
| E2213 |
Pneumatic prop tire insert |
270 |
268 |
$12K |
| E2607 |
Skin pro/pos wc cus wd <22in |
46 |
39 |
$10K |
| K0823 |
Pwc gp 2 std cap chair |
27 |
27 |
$7K |
| E0978 |
W/c acc,saf belt pelv strap |
276 |
220 |
$6K |
| E0950 |
Tray |
14 |
13 |
$980.76 |
| E2361 |
22nf sealed leadacid battery |
16 |
16 |
$260.78 |