| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
1,839 |
1,839 |
$274K |
| E2510 |
Sgd w multi methods msg/accs |
26 |
26 |
$109K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,243 |
2,117 |
$57K |
| K0108 |
W/c component-accessory nos |
893 |
628 |
$50K |
| E0955 |
Cushioned headrest |
1,943 |
1,932 |
$31K |
| E2617 |
Custom fab w/c back cushion |
61 |
61 |
$30K |
| E2609 |
Custom fabricate w/c cushion |
44 |
44 |
$23K |
| K0040 |
Adjustable angle footplate |
455 |
368 |
$21K |
| E0971 |
Wheelchair anti-tipping devi |
462 |
377 |
$13K |
| E0960 |
W/c shoulder harness/straps |
132 |
131 |
$6K |
| E1028 |
W/c manual swingaway |
2,827 |
2,055 |
$5K |
| E0973 |
W/ch access det adj armrest |
274 |
199 |
$5K |
| E2213 |
Pneumatic prop tire insert |
137 |
113 |
$4K |
| E0951 |
Loop heel |
261 |
213 |
$3K |
| E0978 |
W/c acc,saf belt pelv strap |
311 |
307 |
$2K |
| E2206 |
Man wc whl lock comp repl ea |
73 |
61 |
$2K |
| E0956 |
W/c lateral trunk/hip suppor |
42 |
27 |
$2K |
| K0019 |
Arm pad repl, each |
102 |
76 |
$710.91 |
| E2607 |
Skin pro/pos wc cus wd <22in |
13 |
13 |
$698.19 |
| K0077 |
Fr cstr asmb sol tire rep ea |
23 |
14 |
$465.62 |
| E2392 |
Solid caster tire, integrate |
27 |
12 |
$256.88 |