| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0005 |
Ultralightweight wheelchair |
15 |
15 |
$3K |
| E0990 |
Wheelchair accessory, elevating leg rest, complete assembly, each |
12 |
12 |
$200.00 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
15 |
15 |
$96.00 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
15 |
15 |
$96.00 |
| E2218 |
Manual wheelchair accessory, foam propulsion tire, any size, each |
15 |
15 |
$19.50 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
14 |
14 |
$0.00 |