| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
1,186 |
609 |
$1.17M |
| K0108 |
W/c component-accessory nos |
3,399 |
1,632 |
$561K |
| E1028 |
W/c manual swingaway |
2,435 |
1,301 |
$225K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,054 |
1,709 |
$63K |
| E1161 |
Manual adult wc w tiltinspac |
31 |
25 |
$18K |
| E0973 |
W/ch access det adj armrest |
127 |
102 |
$17K |
| E0956 |
W/c lateral trunk/hip suppor |
92 |
75 |
$15K |
| E0960 |
W/c shoulder harness/straps |
153 |
137 |
$11K |
| K0040 |
Adjustable angle footplate |
116 |
93 |
$10K |
| E0978 |
W/c acc,saf belt pelv strap |
301 |
255 |
$8K |
| E0971 |
Wheelchair anti-tipping devi |
45 |
40 |
$3K |
| E2211 |
Pneumatic propulsion tire |
21 |
12 |
$780.31 |
| E0955 |
Cushioned headrest |
15 |
12 |
$253.87 |