| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
1,691 |
346 |
$606K |
| K0108 |
W/c component-accessory nos |
6,087 |
2,466 |
$496K |
| E1028 |
W/c manual swingaway |
7,926 |
3,448 |
$345K |
| K0739 |
Repair/svc dme non-oxygen eq |
5,999 |
4,686 |
$262K |
| E0955 |
Cushioned headrest |
2,311 |
1,876 |
$115K |
| E1161 |
Manual adult wc w tiltinspac |
362 |
319 |
$58K |
| E0956 |
W/c lateral trunk/hip suppor |
593 |
318 |
$33K |
| E0973 |
W/ch access det adj armrest |
539 |
364 |
$32K |
| A9900 |
Supply/accessory/service |
68 |
59 |
$17K |
| E0960 |
W/c shoulder harness/straps |
273 |
194 |
$15K |
| K0040 |
Adjustable angle footplate |
334 |
221 |
$15K |
| E0978 |
W/c acc,saf belt pelv strap |
647 |
491 |
$13K |
| E2607 |
Skin pro/pos wc cus wd <22in |
63 |
49 |
$9K |
| E0971 |
Wheelchair anti-tipping devi |
207 |
141 |
$7K |
| E2613 |
Position back cush wd <22in |
38 |
25 |
$6K |
| E2213 |
Pneumatic prop tire insert |
189 |
125 |
$4K |
| E2361 |
22nf sealed leadacid battery |
31 |
24 |
$4K |
| E2211 |
Pneumatic propulsion tire |
81 |
50 |
$2K |
| E0951 |
Loop heel |
162 |
97 |
$2K |
| E0950 |
Tray |
15 |
12 |
$787.33 |
| K0019 |
Arm pad repl, each |
38 |
25 |
$655.97 |
| E0961 |
Wheelchair brake extension |
32 |
26 |
$628.56 |
| K0004 |
High strength ltwt whlchr |
12 |
12 |
$464.85 |
| E2392 |
Solid caster tire, integrate |
20 |
13 |
$445.26 |
| E2394 |
Drive wheel excludes tire |
18 |
14 |
$413.86 |