| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0003 |
Lightweight wheelchair |
1,240 |
1,236 |
$19K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
327 |
317 |
$12K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
163 |
83 |
$5K |
| E1161 |
Manual adult size wheelchair, includes tilt in space |
132 |
132 |
$5K |
| E2387 |
Power wheelchair accessory, foam filled caster tire, any size, replacement only, each |
118 |
59 |
$2K |
| E2392 |
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
47 |
25 |
$695.87 |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
14 |
12 |
$473.92 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
26 |
25 |
$232.74 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
14 |
12 |
$150.65 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
90 |
87 |
$111.46 |
| E2210 |
Wheelchair accessory, bearings, any type, replacement only, each |
27 |
27 |
$72.61 |