| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Pwc gp 2 std cap chair |
2,132 |
1,759 |
$121K |
| T4541 |
Large disposable underpad |
1,686 |
1,494 |
$59K |
| E1007 |
Pwr seat combo w/shear |
13 |
12 |
$34K |
| K0816 |
Pwc gp 1 std cap chair |
971 |
574 |
$29K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,549 |
801 |
$16K |
| E1028 |
W/c manual swingaway |
246 |
105 |
$12K |
| E2365 |
U1 sealed leadacid battery |
335 |
244 |
$10K |
| E2311 |
Electro connect btw 2 sys |
13 |
12 |
$9K |
| E2386 |
Foam filled drive wheel tire |
158 |
85 |
$5K |
| E2387 |
Foam filled caster tire |
209 |
115 |
$5K |
| E2395 |
Caster wheel excludes tire |
211 |
116 |
$4K |
| E2394 |
Drive wheel excludes tire |
159 |
85 |
$3K |
| E2396 |
Caster fork |
159 |
91 |
$2K |
| E0955 |
Cushioned headrest |
65 |
55 |
$2K |
| K0195 |
Elevating whlchair leg rests |
841 |
722 |
$2K |
| E2377 |
Expandable controller, initl |
13 |
12 |
$2K |
| E2313 |
Pwc harness, expand control |
13 |
12 |
$1K |
| A5500 |
Diab shoe for density insert |
25 |
12 |
$212.91 |
| K0815 |
Pwc gp 1 std seat/back |
12 |
12 |
$204.94 |
| A5512 |
Multi den insert direct form |
25 |
12 |
$75.70 |