| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
5,805 |
2,307 |
$502K |
| E1161 |
Manual adult wc w tiltinspac |
1,315 |
1,059 |
$281K |
| E1028 |
W/c manual swingaway |
6,591 |
3,001 |
$240K |
| K0739 |
Repair/svc dme non-oxygen eq |
4,368 |
3,446 |
$169K |
| E0955 |
Cushioned headrest |
2,075 |
1,693 |
$75K |
| E1399 |
Durable medical equipment mi |
127 |
27 |
$55K |
| E0973 |
W/ch access det adj armrest |
1,051 |
667 |
$53K |
| K0823 |
Pwc gp 2 std cap chair |
402 |
344 |
$30K |
| K0040 |
Adjustable angle footplate |
465 |
291 |
$22K |
| E0971 |
Wheelchair anti-tipping devi |
646 |
455 |
$20K |
| K0005 |
Ultralightweight wheelchair |
14 |
12 |
$11K |
| E0956 |
W/c lateral trunk/hip suppor |
166 |
86 |
$9K |
| E2361 |
22nf sealed leadacid battery |
83 |
64 |
$8K |
| E0978 |
W/c acc,saf belt pelv strap |
511 |
404 |
$6K |
| E2620 |
Wc planar back cush wd <22in |
36 |
28 |
$6K |
| E0951 |
Loop heel |
353 |
239 |
$4K |
| E0960 |
W/c shoulder harness/straps |
45 |
38 |
$2K |
| E2392 |
Solid caster tire, integrate |
35 |
32 |
$2K |
| E2386 |
Foam filled drive wheel tire |
15 |
14 |
$2K |
| E2607 |
Skin pro/pos wc cus wd <22in |
14 |
12 |
$1K |
| E0961 |
Wheelchair brake extension |
60 |
38 |
$956.46 |
| E2394 |
Drive wheel excludes tire |
15 |
13 |
$825.54 |
| K0019 |
Arm pad repl, each |
70 |
54 |
$662.29 |
| K0004 |
High strength ltwt whlchr |
14 |
12 |
$329.16 |