| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
1,819 |
843 |
$761K |
| E1161 |
Manual adult wc w tiltinspac |
639 |
532 |
$189K |
| K0005 |
Ultralightweight wheelchair |
125 |
74 |
$96K |
| E1028 |
W/c manual swingaway |
1,959 |
1,215 |
$76K |
| E1399 |
Durable medical equipment mi |
30 |
24 |
$54K |
| K0823 |
Pwc gp 2 std cap chair |
572 |
405 |
$50K |
| E0973 |
W/ch access det adj armrest |
684 |
369 |
$33K |
| K0739 |
Repair/svc dme non-oxygen eq |
898 |
622 |
$31K |
| E0955 |
Cushioned headrest |
871 |
701 |
$19K |
| E0971 |
Wheelchair anti-tipping devi |
562 |
312 |
$17K |
| E2613 |
Position back cush wd <22in |
96 |
54 |
$12K |
| K0040 |
Adjustable angle footplate |
159 |
89 |
$8K |
| E2607 |
Skin pro/pos wc cus wd <22in |
70 |
43 |
$6K |
| E0978 |
W/c acc,saf belt pelv strap |
164 |
116 |
$4K |
| E2620 |
Wc planar back cush wd <22in |
26 |
13 |
$3K |
| E0961 |
Wheelchair brake extension |
172 |
86 |
$2K |
| E0951 |
Loop heel |
193 |
98 |
$2K |
| E2361 |
22nf sealed leadacid battery |
15 |
13 |
$1K |
| E0960 |
W/c shoulder harness/straps |
16 |
12 |
$695.19 |