| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1028 |
W/c manual swingaway |
2,009 |
1,676 |
$708K |
| K0108 |
W/c component-accessory nos |
2,172 |
1,432 |
$648K |
| E0955 |
Cushioned headrest |
1,251 |
1,166 |
$201K |
| T2029 |
Special med equip, noswaiver |
172 |
168 |
$186K |
| E0973 |
W/ch access det adj armrest |
1,151 |
1,053 |
$151K |
| K0040 |
Adjustable angle footplate |
1,047 |
946 |
$122K |
| E0956 |
W/c lateral trunk/hip suppor |
405 |
373 |
$70K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,484 |
2,214 |
$65K |
| E0971 |
Wheelchair anti-tipping devi |
881 |
816 |
$51K |
| Z0160 |
|
391 |
332 |
$45K |
| E2607 |
Skin pro/pos wc cus wd <22in |
170 |
160 |
$42K |
| E0960 |
W/c shoulder harness/straps |
446 |
414 |
$35K |
| E2213 |
Pneumatic prop tire insert |
658 |
602 |
$33K |
| E0978 |
W/c acc,saf belt pelv strap |
949 |
892 |
$30K |
| E2361 |
22nf sealed leadacid battery |
111 |
102 |
$20K |
| E2613 |
Position back cush wd <22in |
42 |
40 |
$14K |
| E2210 |
Wheelchair bearings |
315 |
281 |
$8K |
| E2231 |
Solid seat support base |
61 |
54 |
$8K |
| E2620 |
Wc planar back cush wd <22in |
13 |
12 |
$6K |
| E0951 |
Loop heel |
249 |
222 |
$5K |
| K0070 |
Rr whl compl pne tire rep ea |
15 |
13 |
$5K |
| E0961 |
Wheelchair brake extension |
147 |
131 |
$3K |
| E2395 |
Caster wheel excludes tire |
13 |
12 |
$1K |
| E0953 |
W/c lateral thigh/knee sup |
16 |
13 |
$1K |
| E2205 |
Manual wc accessory, handrim |
13 |
12 |
$742.82 |