| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2370 |
Pwr wc dr wh motor/gear comb |
2,038 |
1,064 |
$161K |
| E0973 |
W/ch access det adj armrest |
1,789 |
876 |
$107K |
| E2375 |
Non-expandable controller |
1,134 |
1,102 |
$107K |
| E2374 |
Hand/chin ctrl std joystick |
1,071 |
1,044 |
$85K |
| E2386 |
Foam filled drive wheel tire |
2,605 |
1,287 |
$56K |
| E2366 |
Battery charger, single mode |
1,282 |
1,235 |
$42K |
| K0108 |
W/c component-accessory nos |
1,263 |
669 |
$35K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,326 |
2,256 |
$33K |
| E2365 |
U1 sealed leadacid battery |
705 |
674 |
$27K |
| E2395 |
Caster wheel excludes tire |
2,625 |
1,195 |
$23K |
| K0462 |
Temporary replacement eqpmnt |
297 |
293 |
$20K |
| E2394 |
Drive wheel excludes tire |
1,248 |
619 |
$15K |
| E2389 |
Foam caster tire |
1,475 |
665 |
$10K |
| E2387 |
Foam filled caster tire |
865 |
411 |
$9K |
| E2210 |
Wheelchair bearings |
1,306 |
1,272 |
$8K |
| E2396 |
Caster fork |
822 |
378 |
$8K |
| E1028 |
W/c manual swingaway |
159 |
157 |
$2K |
| K0040 |
Adjustable angle footplate |
205 |
150 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
347 |
334 |
$2K |
| E2392 |
Solid caster tire, integrate |
189 |
92 |
$2K |
| E2361 |
22nf sealed leadacid battery |
14 |
14 |
$588.68 |
| K0019 |
Arm pad repl, each |
55 |
27 |
$29.46 |