| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
2,478 |
848 |
$638K |
| K0108 |
W/c component-accessory nos |
1,937 |
849 |
$239K |
| E1028 |
W/c manual swingaway |
2,886 |
1,538 |
$165K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,362 |
2,604 |
$103K |
| E1161 |
Manual adult wc w tiltinspac |
159 |
122 |
$48K |
| E0955 |
Cushioned headrest |
923 |
705 |
$43K |
| E0973 |
W/ch access det adj armrest |
266 |
183 |
$22K |
| K0040 |
Adjustable angle footplate |
94 |
64 |
$5K |
| E0971 |
Wheelchair anti-tipping devi |
104 |
76 |
$5K |
| E0978 |
W/c acc,saf belt pelv strap |
165 |
122 |
$3K |
| E2211 |
Pneumatic propulsion tire |
71 |
52 |
$3K |
| E0960 |
W/c shoulder harness/straps |
35 |
29 |
$2K |
| E0951 |
Loop heel |
17 |
12 |
$343.34 |