| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1002 |
Pwr seat tilt |
657 |
551 |
$853K |
| K0821 |
Pwc gp 2 std port cap chair |
15,810 |
11,819 |
$849K |
| E2311 |
Electro connect btw 2 sys |
828 |
676 |
$599K |
| E1012 |
Ctr mount pwr elev leg rest |
762 |
647 |
$359K |
| K0825 |
Pwc gp 2 hd cap chair |
3,399 |
2,647 |
$339K |
| E1028 |
W/c manual swingaway |
5,348 |
3,044 |
$266K |
| K0823 |
Pwc gp 2 std cap chair |
1,216 |
1,084 |
$233K |
| E1007 |
Pwr seat combo w/shear |
54 |
43 |
$167K |
| E1161 |
Manual adult wc w tiltinspac |
1,050 |
875 |
$163K |
| E2361 |
22nf sealed leadacid battery |
1,677 |
1,313 |
$152K |
| E0973 |
W/ch access det adj armrest |
4,284 |
2,207 |
$126K |
| E0955 |
Cushioned headrest |
2,627 |
2,091 |
$104K |
| K0816 |
Pwc gp 1 std cap chair |
2,793 |
2,743 |
$100K |
| E2365 |
U1 sealed leadacid battery |
2,359 |
1,844 |
$90K |
| E2298 |
Pwr seat elev sys for crt |
166 |
161 |
$68K |
| K0835 |
Pwc gp2 std sing pow opt s/b |
34 |
29 |
$62K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
36 |
29 |
$60K |
| K0836 |
Pwc gp2 std sing pow opt cap |
64 |
63 |
$52K |
| E2377 |
Expandable controller, initl |
260 |
211 |
$38K |
| K0040 |
Adjustable angle footplate |
1,011 |
571 |
$37K |
| E2313 |
Pwc harness, expand control |
257 |
213 |
$28K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,683 |
1,308 |
$24K |
| K0003 |
Lightweight wheelchair |
2,015 |
1,845 |
$23K |
| K0001 |
Standard wheelchair |
2,375 |
2,203 |
$21K |
| E2620 |
Wc planar back cush wd <22in |
110 |
88 |
$15K |
| E0971 |
Wheelchair anti-tipping devi |
837 |
483 |
$15K |
| L1833 |
Ko adj jnt pos r sup pre ots |
55 |
55 |
$13K |
| E2611 |
Gen use back cush wdth <22in |
242 |
208 |
$12K |
| E2300 |
Pwr seat elevation sys |
20 |
18 |
$10K |
| K0005 |
Ultralightweight wheelchair |
13 |
12 |
$9K |
| K0002 |
Stnd hemi (low seat) whlchr |
757 |
705 |
$7K |
| L0648 |
Lso sag r an/pos pnl pre ots |
41 |
38 |
$6K |
| E0978 |
W/c acc,saf belt pelv strap |
648 |
512 |
$5K |
| K0195 |
Elevating whlchair leg rests |
2,104 |
1,832 |
$4K |
| E2607 |
Skin pro/pos wc cus wd <22in |
37 |
26 |
$3K |
| E2601 |
Gen w/c cushion wdth < 22 in |
184 |
165 |
$3K |
| K0108 |
W/c component-accessory nos |
36 |
30 |
$3K |
| E1225 |
Manual semi-reclining back |
18 |
12 |
$2K |
| E0143 |
Walker folding wheeled w/o s |
163 |
160 |
$2K |
| E1390 |
Oxygen concentrator |
46 |
40 |
$2K |
| E2213 |
Pneumatic prop tire insert |
62 |
37 |
$1K |
| E2366 |
Battery charger, single mode |
16 |
13 |
$683.55 |
| E0961 |
Wheelchair brake extension |
48 |
25 |
$651.72 |
| E0951 |
Loop heel |
76 |
41 |
$621.99 |
| E1088 |
Wheelchair lightweight det a |
103 |
96 |
$494.83 |
| E2211 |
Pneumatic propulsion tire |
25 |
13 |
$370.76 |
| E0990 |
Wheelchair elevating leg res |
15 |
12 |
$178.10 |
| E0156 |
Walker seat attachment |
15 |
15 |
$40.29 |