| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
3,685 |
756 |
$2.36M |
| K0108 |
W/c component-accessory nos |
5,813 |
2,437 |
$568K |
| E1028 |
W/c manual swingaway |
5,656 |
2,709 |
$304K |
| E1161 |
Manual adult wc w tiltinspac |
1,640 |
1,352 |
$293K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,901 |
2,998 |
$160K |
| E0955 |
Cushioned headrest |
2,704 |
2,170 |
$91K |
| E0973 |
W/ch access det adj armrest |
940 |
657 |
$67K |
| E0960 |
W/c shoulder harness/straps |
1,139 |
801 |
$41K |
| E0956 |
W/c lateral trunk/hip suppor |
567 |
237 |
$36K |
| E1236 |
Folding ped wc adjustable |
37 |
25 |
$29K |
| K0040 |
Adjustable angle footplate |
588 |
392 |
$29K |
| E0978 |
W/c acc,saf belt pelv strap |
1,264 |
926 |
$25K |
| E0971 |
Wheelchair anti-tipping devi |
592 |
433 |
$22K |
| E2607 |
Skin pro/pos wc cus wd <22in |
179 |
134 |
$20K |
| E0951 |
Loop heel |
859 |
560 |
$11K |
| E2620 |
Wc planar back cush wd <22in |
52 |
37 |
$10K |
| E2213 |
Pneumatic prop tire insert |
463 |
333 |
$10K |
| E2211 |
Pneumatic propulsion tire |
224 |
163 |
$6K |
| E0950 |
Tray |
75 |
64 |
$4K |
| E2622 |
Adj skin pro w/c cus wd<22in |
35 |
25 |
$4K |
| E2361 |
22nf sealed leadacid battery |
31 |
24 |
$2K |
| E0952 |
Toe loop/holder, each |
136 |
67 |
$2K |
| E0966 |
Wheelchair head rest extensi |
35 |
25 |
$1K |
| E2231 |
Solid seat support base |
14 |
13 |
$668.05 |