| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
174 |
41 |
$110K |
| E1028 |
W/c manual swingaway |
2,513 |
1,125 |
$90K |
| E1161 |
Manual adult wc w tiltinspac |
443 |
230 |
$88K |
| K0005 |
Ultralightweight wheelchair |
117 |
52 |
$57K |
| K0108 |
W/c component-accessory nos |
459 |
196 |
$33K |
| E0955 |
Cushioned headrest |
1,136 |
661 |
$29K |
| E0973 |
W/ch access det adj armrest |
745 |
313 |
$24K |
| E1012 |
Ctr mount pwr elev leg rest |
42 |
24 |
$17K |
| K0739 |
Repair/svc dme non-oxygen eq |
754 |
517 |
$17K |
| E2311 |
Electro connect btw 2 sys |
17 |
12 |
$15K |
| E0971 |
Wheelchair anti-tipping devi |
583 |
229 |
$10K |
| K0040 |
Adjustable angle footplate |
104 |
53 |
$3K |
| E0951 |
Loop heel |
263 |
92 |
$2K |
| E0961 |
Wheelchair brake extension |
206 |
55 |
$2K |
| E0956 |
W/c lateral trunk/hip suppor |
27 |
13 |
$1K |
| E0978 |
W/c acc,saf belt pelv strap |
78 |
50 |
$783.56 |