| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0823 |
Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds |
194 |
194 |
$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 |
686 |
655 |
$18K |
| E1399 |
Durable medical equipment, miscellaneous |
13 |
13 |
$7K |
| E2386 |
Power wheelchair accessory, foam filled drive wheel tire, any size, replacement only, each |
82 |
81 |
$6K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
266 |
254 |
$5K |
| E2366 |
Power wheelchair accessory, battery charger, single mode, for use with only one battery type, sealed or non-sealed, each |
67 |
67 |
$4K |
| E2395 |
Power wheelchair accessory, caster wheel excludes tire, any size, replacement only, each |
67 |
67 |
$3K |
| E2394 |
Power wheelchair accessory, drive wheel excludes tire, any size, replacement only, each |
41 |
41 |
$2K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
40 |
39 |
$1K |
| E2365 |
Power wheelchair accessory, u-1 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
12 |
12 |
$1K |
| E2389 |
Power wheelchair accessory, foam caster tire, any size, replacement only, each |
12 |
12 |
$75.96 |