| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
824 |
823 |
$37K |
| K0462 |
Temporary replacement for patient owned equipment being repaired, any type |
336 |
334 |
$28K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
548 |
546 |
$13K |
| K0003 |
Lightweight wheelchair |
971 |
970 |
$11K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
742 |
376 |
$10K |
| K0001 |
Standard wheelchair |
1,108 |
1,107 |
$10K |
| E2375 |
Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only |
44 |
44 |
$8K |
| E2321 |
Power wheelchair accessory, hand control interface, remote joystick, nonproportional, including all related electronics, mechanical stop switch, and fixed mounting hardware |
50 |
50 |
$3K |
| E2366 |
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
181 |
179 |
$3K |
| E2384 |
Power wheelchair accessory, pneumatic caster tire, any size, replacement only, each |
200 |
62 |
$2K |
| E2361 |
Power wheelchair accessory, 22nf sealed lead acid battery, each, (e.g., gel cell, absorbed glassmat) |
26 |
26 |
$2K |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
12 |
12 |
$1K |
| E2370 |
Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only |
33 |
26 |
$844.90 |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
113 |
57 |
$796.35 |
| E2611 |
General use wheelchair back cushion, width less than 22 inches, any height, including any type mounting hardware |
13 |
13 |
$576.82 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
116 |
63 |
$529.28 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
50 |
25 |
$514.44 |
| E2396 |
Power wheelchair accessory, caster fork, any size, replacement only, each |
12 |
12 |
$507.28 |
| E2219 |
Manual wheelchair accessory, foam caster tire, any size, each |
24 |
12 |
$447.56 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
56 |
28 |
$275.87 |
| K0195 |
Elevating leg rests, pair (for use with capped rental wheelchair base) |
307 |
307 |
$233.40 |
| K0052 |
Swingaway, detachable footrests, replacement only, each |
24 |
12 |
$129.10 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
26 |
26 |
$107.28 |
| E2601 |
General use wheelchair seat cushion, width less than 22 inches, any depth |
13 |
13 |
$50.84 |