| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
2,521 |
1,507 |
$628K |
| E1028 |
W/c manual swingaway |
804 |
525 |
$112K |
| E1399 |
Durable medical equipment mi |
58 |
39 |
$69K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,380 |
1,010 |
$44K |
| E0960 |
W/c shoulder harness/straps |
661 |
448 |
$36K |
| E0978 |
W/c acc,saf belt pelv strap |
882 |
614 |
$36K |
| E0955 |
Cushioned headrest |
315 |
223 |
$30K |
| E0973 |
W/ch access det adj armrest |
252 |
179 |
$28K |
| K0040 |
Adjustable angle footplate |
320 |
223 |
$27K |
| E2607 |
Skin pro/pos wc cus wd <22in |
120 |
81 |
$21K |
| E0971 |
Wheelchair anti-tipping devi |
308 |
225 |
$21K |
| E0956 |
W/c lateral trunk/hip suppor |
80 |
54 |
$14K |
| E2613 |
Position back cush wd <22in |
19 |
14 |
$6K |
| E2213 |
Pneumatic prop tire insert |
92 |
66 |
$3K |
| E0950 |
Tray |
25 |
17 |
$3K |
| E2211 |
Pneumatic propulsion tire |
18 |
12 |
$273.23 |