| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| K0003 |
Lightweight wheelchair |
112 |
106 |
$2K |
| L3916 |
Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf |
78 |
77 |
$2K |
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
13 |
13 |
$1K |
| K0001 |
Standard wheelchair |
81 |
79 |
$483.14 |
| L1851 |
Knee orthosis (ko), single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/valgus adjustment, prefabricated, off-the-shelf |
16 |
15 |
$0.00 |
| L2397 |
Addition to lower extremity orthosis, suspension sleeve |
17 |
16 |
$0.00 |