| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2311 |
Electro connect btw 2 sys |
221 |
153 |
$122K |
| E1002 |
Pwr seat tilt |
92 |
65 |
$81K |
| K0821 |
Pwc gp 2 std port cap chair |
1,308 |
828 |
$34K |
| K0823 |
Pwc gp 2 std cap chair |
540 |
425 |
$33K |
| E1012 |
Ctr mount pwr elev leg rest |
586 |
417 |
$31K |
| E1028 |
W/c manual swingaway |
1,069 |
560 |
$28K |
| E2361 |
22nf sealed leadacid battery |
127 |
85 |
$8K |
| E0955 |
Cushioned headrest |
215 |
136 |
$8K |
| E2377 |
Expandable controller, initl |
19 |
12 |
$2K |
| K0040 |
Adjustable angle footplate |
78 |
40 |
$2K |
| E2313 |
Pwc harness, expand control |
19 |
12 |
$2K |
| E2365 |
U1 sealed leadacid battery |
38 |
24 |
$1K |
| E0973 |
W/ch access det adj armrest |
48 |
14 |
$385.98 |