| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
Wheelchair component or accessory, not otherwise specified |
371 |
191 |
$69K |
| K0005 |
Ultralightweight wheelchair |
42 |
42 |
$67K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
254 |
130 |
$31K |
| E2607 |
Skin protection and positioning wheelchair seat cushion, width less than 22 inches, any depth |
91 |
86 |
$15K |
| E2620 |
Positioning wheelchair back cushion, planar back with lateral supports, width less than 22 inches, any height, including any type mounting hardware |
37 |
37 |
$11K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
140 |
131 |
$10K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
74 |
71 |
$8K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
128 |
123 |
$6K |
| E2219 |
Manual wheelchair accessory, foam caster tire, any size, each |
29 |
27 |
$2K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
28 |
26 |
$1K |
| K0040 |
Adjustable angle footplate, each |
15 |
14 |
$1K |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
43 |
43 |
$867.89 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
12 |
12 |
$326.65 |