| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0739 |
Repair/svc dme non-oxygen eq |
3,843 |
3,463 |
$275K |
| K0108 |
W/c component-accessory nos |
2,586 |
1,634 |
$270K |
| E1161 |
Manual adult wc w tiltinspac |
2,485 |
2,477 |
$224K |
| E1028 |
W/c manual swingaway |
6,327 |
3,847 |
$151K |
| E0955 |
Cushioned headrest |
3,043 |
3,010 |
$43K |
| E0973 |
W/ch access det adj armrest |
277 |
237 |
$15K |
| K0040 |
Adjustable angle footplate |
159 |
132 |
$7K |
| E0978 |
W/c acc,saf belt pelv strap |
323 |
313 |
$5K |
| E2213 |
Pneumatic prop tire insert |
178 |
160 |
$5K |
| E0956 |
W/c lateral trunk/hip suppor |
53 |
39 |
$4K |
| E2211 |
Pneumatic propulsion tire |
117 |
104 |
$3K |
| E0971 |
Wheelchair anti-tipping devi |
84 |
73 |
$2K |
| E0951 |
Loop heel |
109 |
90 |
$969.32 |
| K0019 |
Arm pad repl, each |
12 |
12 |
$160.72 |