| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
237 |
218 |
$447K |
| E1161 |
Manual adult wc w tiltinspac |
2,311 |
2,295 |
$401K |
| K0108 |
W/c component-accessory nos |
618 |
470 |
$165K |
| E0955 |
Cushioned headrest |
2,611 |
2,596 |
$73K |
| E1028 |
W/c manual swingaway |
2,654 |
2,350 |
$51K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,608 |
1,528 |
$44K |
| K0040 |
Adjustable angle footplate |
393 |
339 |
$23K |
| E0971 |
Wheelchair anti-tipping devi |
515 |
383 |
$15K |
| E0960 |
W/c shoulder harness/straps |
132 |
129 |
$6K |
| E2213 |
Pneumatic prop tire insert |
82 |
81 |
$3K |
| E0973 |
W/ch access det adj armrest |
53 |
38 |
$2K |
| E2620 |
Wc planar back cush wd <22in |
12 |
12 |
$2K |
| E0951 |
Loop heel |
136 |
104 |
$2K |
| K0003 |
Lightweight wheelchair |
36 |
36 |
$1K |
| E2607 |
Skin pro/pos wc cus wd <22in |
12 |
12 |
$1K |
| E0978 |
W/c acc,saf belt pelv strap |
160 |
158 |
$1K |
| E0260 |
Hosp bed semi-electr w/ matt |
12 |
12 |
$405.92 |
| K0001 |
Standard wheelchair |
24 |
24 |
$48.51 |