| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2609 |
Custom fabricate w/c cushion |
1,368 |
1,150 |
$1.87M |
| E2617 |
Custom fab w/c back cushion |
1,068 |
926 |
$1.50M |
| K0108 |
W/c component-accessory nos |
5,365 |
2,955 |
$1.29M |
| E1161 |
Manual adult wc w tiltinspac |
4,861 |
3,381 |
$1.27M |
| E1399 |
Durable medical equipment mi |
855 |
393 |
$1.09M |
| E1028 |
W/c manual swingaway |
6,831 |
4,205 |
$446K |
| E0955 |
Cushioned headrest |
5,708 |
4,162 |
$208K |
| K0739 |
Repair/svc dme non-oxygen eq |
7,183 |
4,530 |
$148K |
| E0973 |
W/ch access det adj armrest |
1,322 |
1,038 |
$136K |
| E0986 |
Man w/c powr assist syst |
180 |
124 |
$104K |
| K0040 |
Adjustable angle footplate |
1,468 |
1,096 |
$102K |
| E0971 |
Wheelchair anti-tipping devi |
1,157 |
894 |
$53K |
| E0978 |
W/c acc,saf belt pelv strap |
1,537 |
1,334 |
$37K |
| E0960 |
W/c shoulder harness/straps |
480 |
427 |
$29K |
| E1236 |
Folding ped wc adjustable |
75 |
67 |
$25K |
| K0005 |
Ultralightweight wheelchair |
12 |
12 |
$16K |
| E0956 |
W/c lateral trunk/hip suppor |
72 |
54 |
$10K |
| E2607 |
Skin pro/pos wc cus wd <22in |
55 |
49 |
$10K |
| E2359 |
Gr34 sealed leadacid battery |
31 |
27 |
$7K |
| E2620 |
Wc planar back cush wd <22in |
13 |
12 |
$4K |
| E2213 |
Pneumatic prop tire insert |
111 |
78 |
$3K |
| E2377 |
Expandable controller, initl |
12 |
12 |
$3K |
| E2622 |
Adj skin pro w/c cus wd<22in |
16 |
13 |
$3K |
| E2313 |
Pwc harness, expand control |
13 |
12 |
$2K |
| E0950 |
Tray |
14 |
12 |
$715.96 |
| E0954 |
Foot box, any type each foot |
17 |
12 |
$679.70 |
| E0951 |
Loop heel |
29 |
12 |
$141.40 |