| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1007 |
Pwr seat combo w/shear |
3,550 |
2,413 |
$14.64M |
| E1161 |
Manual adult wc w tiltinspac |
8,396 |
5,497 |
$10.64M |
| E2609 |
Custom fabricate w/c cushion |
13,003 |
8,856 |
$9.16M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
2,475 |
1,642 |
$7.67M |
| E2617 |
Custom fab w/c back cushion |
12,881 |
8,794 |
$7.27M |
| E2311 |
Electro connect btw 2 sys |
3,621 |
2,465 |
$4.18M |
| E1012 |
Ctr mount pwr elev leg rest |
3,018 |
1,982 |
$3.26M |
| E1028 |
W/c manual swingaway |
20,210 |
8,981 |
$2.71M |
| K0108 |
W/c component-accessory nos |
11,717 |
6,128 |
$1.90M |
| K0005 |
Ultralightweight wheelchair |
1,333 |
838 |
$1.64M |
| E2203 |
Frame depth less than 22 in |
5,782 |
3,781 |
$1.59M |
| E0955 |
Cushioned headrest |
12,369 |
8,080 |
$1.39M |
| E2204 |
Frame depth 22 to 25 in |
2,546 |
1,713 |
$1.18M |
| E0973 |
W/ch access det adj armrest |
11,812 |
7,729 |
$1.11M |
| E0990 |
Wheelchair elevating leg res |
9,064 |
5,927 |
$994K |
| K0040 |
Adjustable angle footplate |
12,029 |
7,867 |
$979K |
| K0862 |
Pwc gp3 hd mult pow opt s/b |
289 |
160 |
$877K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
4,037 |
2,706 |
$868K |
| E0956 |
W/c lateral trunk/hip suppor |
8,294 |
4,453 |
$839K |
| E1002 |
Pwr seat tilt |
443 |
263 |
$822K |
| E2231 |
Solid seat support base |
9,179 |
5,989 |
$767K |
| E2377 |
Expandable controller, initl |
3,731 |
2,516 |
$765K |
| E2313 |
Pwc harness, expand control |
3,764 |
2,533 |
$588K |
| E2361 |
22nf sealed leadacid battery |
3,248 |
2,231 |
$519K |
| E0971 |
Wheelchair anti-tipping devi |
9,249 |
6,032 |
$453K |
| E0954 |
Foot box, any type each foot |
3,943 |
2,352 |
$445K |
| E2211 |
Pneumatic propulsion tire |
8,174 |
5,439 |
$307K |
| E2213 |
Pneumatic prop tire insert |
8,482 |
5,626 |
$281K |
| E2363 |
Gr24 sealed leadacid battery |
1,058 |
669 |
$221K |
| E0961 |
Wheelchair brake extension |
6,311 |
4,164 |
$176K |
| E1225 |
Manual semi-reclining back |
966 |
519 |
$141K |
| E0953 |
W/c lateral thigh/knee sup |
660 |
391 |
$110K |
| E1010 |
Add pwr leg elevation |
187 |
139 |
$107K |
| E0978 |
W/c acc,saf belt pelv strap |
4,929 |
3,438 |
$100K |
| E2343 |
W/c dpth 22-25 in seat frame |
243 |
134 |
$87K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,441 |
3,158 |
$76K |
| E2342 |
W/c dpth 20-21 in seat frame |
184 |
117 |
$43K |
| E2208 |
Cylinder tank carrier |
511 |
286 |
$33K |
| E0951 |
Loop heel |
2,541 |
996 |
$33K |
| K0056 |
Seat ht <17 or >=21 ltwt wc |
529 |
314 |
$27K |
| E2340 |
W/c wdth 20-23 in seat frame |
151 |
90 |
$27K |
| E2206 |
Man wc whl lock comp repl ea |
1,238 |
823 |
$21K |
| E0950 |
Tray |
248 |
172 |
$12K |
| E2341 |
W/c wdth 24-27 in seat frame |
25 |
13 |
$10K |
| E2202 |
Seat width 24-27 in |
23 |
14 |
$8K |
| E2366 |
Battery charger, single mode |
75 |
58 |
$7K |
| E2209 |
Arm trough each |
54 |
28 |
$4K |
| K0823 |
Pwc gp 2 std cap chair |
41 |
24 |
$679.11 |
| K0019 |
Arm pad repl, each |
20 |
12 |
$236.05 |