| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1007 |
Pwr seat combo w/shear |
1,676 |
1,286 |
$4.93M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
653 |
484 |
$1.53M |
| E2311 |
Electro connect btw 2 sys |
2,007 |
1,546 |
$1.48M |
| K0823 |
Pwc gp 2 std cap chair |
4,232 |
3,405 |
$780K |
| E1012 |
Ctr mount pwr elev leg rest |
2,063 |
1,592 |
$563K |
| E2377 |
Expandable controller, initl |
1,579 |
1,220 |
$283K |
| E1028 |
W/c manual swingaway |
3,934 |
2,266 |
$266K |
| K0825 |
Pwc gp 2 hd cap chair |
1,001 |
844 |
$246K |
| E2361 |
22nf sealed leadacid battery |
2,613 |
1,919 |
$189K |
| K0821 |
Pwc gp 2 std port cap chair |
3,051 |
2,543 |
$181K |
| E2313 |
Pwc harness, expand control |
1,473 |
1,135 |
$174K |
| E2620 |
Wc planar back cush wd <22in |
537 |
400 |
$121K |
| E0955 |
Cushioned headrest |
2,194 |
1,708 |
$104K |
| K0108 |
W/c component-accessory nos |
1,018 |
602 |
$59K |
| E2365 |
U1 sealed leadacid battery |
987 |
740 |
$44K |
| E2607 |
Skin pro/pos wc cus wd <22in |
218 |
157 |
$30K |
| E1002 |
Pwr seat tilt |
12 |
12 |
$26K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,793 |
1,415 |
$17K |
| K0005 |
Ultralightweight wheelchair |
13 |
12 |
$10K |
| E0973 |
W/ch access det adj armrest |
172 |
107 |
$4K |
| E2603 |
Skin protect wc cus wd <22in |
35 |
32 |
$2K |
| E2366 |
Battery charger, single mode |
33 |
27 |
$2K |
| K0040 |
Adjustable angle footplate |
62 |
40 |
$2K |
| K0195 |
Elevating whlchair leg rests |
361 |
300 |
$620.64 |
| E0978 |
W/c acc,saf belt pelv strap |
33 |
27 |
$301.26 |
| E2211 |
Pneumatic propulsion tire |
23 |
14 |
$221.34 |
| E0971 |
Wheelchair anti-tipping devi |
21 |
13 |
$198.53 |
| E2213 |
Pneumatic prop tire insert |
21 |
13 |
$186.29 |
| E0951 |
Loop heel |
23 |
14 |
$70.55 |