| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Pwc gp 2 std cap chair |
824 |
823 |
$37K |
| K0462 |
Temporary replacement eqpmnt |
336 |
334 |
$28K |
| K0739 |
Repair/svc dme non-oxygen eq |
548 |
546 |
$13K |
| K0003 |
Lightweight wheelchair |
971 |
970 |
$11K |
| E0973 |
W/ch access det adj armrest |
742 |
376 |
$10K |
| K0001 |
Standard wheelchair |
1,108 |
1,107 |
$10K |
| E2375 |
Non-expandable controller |
44 |
44 |
$8K |
| E2321 |
Hand interface joystick |
50 |
50 |
$3K |
| E2366 |
Battery charger, single mode |
181 |
179 |
$3K |
| E2384 |
Pneumatic caster tire |
200 |
62 |
$2K |
| E2361 |
22nf sealed leadacid battery |
26 |
26 |
$2K |
| E2365 |
U1 sealed leadacid battery |
12 |
12 |
$1K |
| E2370 |
Pwr wc dr wh motor/gear comb |
33 |
26 |
$844.90 |
| E2386 |
Foam filled drive wheel tire |
113 |
57 |
$796.35 |
| E2611 |
Gen use back cush wdth <22in |
13 |
13 |
$576.82 |
| E0951 |
Loop heel |
116 |
63 |
$529.28 |
| E0961 |
Wheelchair brake extension |
50 |
25 |
$514.44 |
| E2396 |
Caster fork |
12 |
12 |
$507.28 |
| E2219 |
Foam caster tire any size ea |
24 |
12 |
$447.56 |
| E0971 |
Wheelchair anti-tipping devi |
56 |
28 |
$275.87 |
| K0195 |
Elevating whlchair leg rests |
307 |
307 |
$233.40 |
| K0052 |
Swingaway detach ftrest repl |
24 |
12 |
$129.10 |
| E0978 |
W/c acc,saf belt pelv strap |
26 |
26 |
$107.28 |
| E2601 |
Gen w/c cushion wdth < 22 in |
13 |
13 |
$50.84 |