| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
420 |
284 |
$80K |
| E1028 |
W/c manual swingaway |
119 |
76 |
$17K |
| E0955 |
Cushioned headrest |
68 |
54 |
$8K |
| K0739 |
Repair/svc dme non-oxygen eq |
331 |
280 |
$8K |
| E0973 |
W/ch access det adj armrest |
49 |
41 |
$6K |
| E0971 |
Wheelchair anti-tipping devi |
35 |
28 |
$3K |
| K0040 |
Adjustable angle footplate |
35 |
27 |
$2K |
| E0956 |
W/c lateral trunk/hip suppor |
14 |
12 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
42 |
35 |
$2K |
| E0960 |
W/c shoulder harness/straps |
15 |
12 |
$1K |
| E2213 |
Pneumatic prop tire insert |
14 |
12 |
$538.38 |