| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
5,201 |
2,292 |
$1.13M |
| E1028 |
W/c manual swingaway |
2,766 |
1,417 |
$219K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,067 |
3,108 |
$163K |
| E0955 |
Cushioned headrest |
1,320 |
960 |
$89K |
| E2622 |
Adj skin pro w/c cus wd<22in |
527 |
395 |
$75K |
| E0956 |
W/c lateral trunk/hip suppor |
466 |
226 |
$34K |
| E0973 |
W/ch access det adj armrest |
662 |
445 |
$29K |
| K0040 |
Adjustable angle footplate |
369 |
240 |
$23K |
| E1012 |
Ctr mount pwr elev leg rest |
24 |
12 |
$20K |
| K0077 |
Fr cstr asmb sol tire rep ea |
174 |
115 |
$11K |
| E0978 |
W/c acc,saf belt pelv strap |
483 |
318 |
$10K |
| E1228 |
Wheelchair spec sz spec ht b |
45 |
24 |
$9K |
| K0010 |
Stnd wt frame power whlchr |
69 |
58 |
$9K |
| E1161 |
Manual adult wc w tiltinspac |
14 |
12 |
$8K |
| E0971 |
Wheelchair anti-tipping devi |
178 |
112 |
$6K |
| E2377 |
Expandable controller, initl |
24 |
12 |
$3K |
| E0960 |
W/c shoulder harness/straps |
65 |
49 |
$3K |
| E2213 |
Pneumatic prop tire insert |
71 |
53 |
$2K |
| E2359 |
Gr34 sealed leadacid battery |
15 |
12 |
$2K |
| K0019 |
Arm pad repl, each |
57 |
40 |
$929.04 |
| E2361 |
22nf sealed leadacid battery |
14 |
12 |
$885.60 |
| E2211 |
Pneumatic propulsion tire |
15 |
14 |
$759.62 |
| K0823 |
Pwc gp 2 std cap chair |
14 |
13 |
$393.24 |