| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0001 |
Standard wheelchair |
528 |
523 |
$2K |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
48 |
45 |
$1K |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
106 |
49 |
$593.84 |
| E0143 |
Walker, folding, wheeled, adjustable or fixed height |
48 |
45 |
$439.95 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
57 |
53 |
$351.19 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
100 |
47 |
$271.34 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
52 |
49 |
$226.01 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
486 |
483 |
$139.02 |
| E0156 |
Seat attachment, walker |
14 |
13 |
$49.56 |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
55 |
52 |
$0.00 |