| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
371 |
191 |
$69K |
| K0005 |
Ultralightweight wheelchair |
42 |
42 |
$67K |
| E1028 |
W/c manual swingaway |
254 |
130 |
$31K |
| E2607 |
Skin pro/pos wc cus wd <22in |
91 |
86 |
$15K |
| E2620 |
Wc planar back cush wd <22in |
37 |
37 |
$11K |
| E0973 |
W/ch access det adj armrest |
140 |
131 |
$10K |
| E0955 |
Cushioned headrest |
74 |
71 |
$8K |
| E0971 |
Wheelchair anti-tipping devi |
128 |
123 |
$6K |
| E2219 |
Foam caster tire any size ea |
29 |
27 |
$2K |
| K0739 |
Repair/svc dme non-oxygen eq |
28 |
26 |
$1K |
| K0040 |
Adjustable angle footplate |
15 |
14 |
$1K |
| E0951 |
Loop heel |
43 |
43 |
$867.89 |
| E0961 |
Wheelchair brake extension |
12 |
12 |
$326.65 |