| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
6,333 |
3,094 |
$1.11M |
| E1161 |
Manual adult wc w tiltinspac |
1,595 |
1,568 |
$447K |
| E1028 |
W/c manual swingaway |
5,518 |
3,502 |
$401K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,360 |
4,055 |
$224K |
| E0973 |
W/ch access det adj armrest |
1,451 |
1,216 |
$151K |
| E0955 |
Cushioned headrest |
2,713 |
2,668 |
$136K |
| K0823 |
Pwc gp 2 std cap chair |
501 |
496 |
$87K |
| E2607 |
Skin pro/pos wc cus wd <22in |
275 |
266 |
$67K |
| K0040 |
Adjustable angle footplate |
752 |
667 |
$66K |
| E0960 |
W/c shoulder harness/straps |
525 |
506 |
$58K |
| E0971 |
Wheelchair anti-tipping devi |
692 |
656 |
$46K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
12 |
12 |
$39K |
| E0978 |
W/c acc,saf belt pelv strap |
1,078 |
1,040 |
$36K |
| K0005 |
Ultralightweight wheelchair |
26 |
25 |
$34K |
| E0956 |
W/c lateral trunk/hip suppor |
218 |
163 |
$24K |
| E2213 |
Pneumatic prop tire insert |
609 |
580 |
$22K |
| E1399 |
Durable medical equipment mi |
32 |
12 |
$18K |
| E2211 |
Pneumatic propulsion tire |
339 |
324 |
$14K |
| E2361 |
22nf sealed leadacid battery |
65 |
65 |
$10K |
| K0004 |
High strength ltwt whlchr |
138 |
138 |
$10K |
| E2392 |
Solid caster tire, integrate |
96 |
91 |
$10K |
| E0951 |
Loop heel |
229 |
208 |
$6K |
| E2394 |
Drive wheel excludes tire |
37 |
37 |
$5K |
| E2206 |
Man wc whl lock comp repl ea |
97 |
87 |
$5K |
| E0950 |
Tray |
24 |
24 |
$4K |
| E2624 |
Adj skin pro/pos cus<22in |
14 |
13 |
$4K |
| E2620 |
Wc planar back cush wd <22in |
13 |
13 |
$3K |
| E0961 |
Wheelchair brake extension |
40 |
39 |
$2K |
| E2386 |
Foam filled drive wheel tire |
13 |
13 |
$2K |
| K0019 |
Arm pad repl, each |
100 |
93 |
$2K |
| K0077 |
Fr cstr asmb sol tire rep ea |
15 |
13 |
$1K |