| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1007 |
Pwr seat combo w/shear |
695 |
506 |
$2.05M |
| E2311 |
Electro connect btw 2 sys |
1,026 |
761 |
$824K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
118 |
86 |
$283K |
| E1012 |
Ctr mount pwr elev leg rest |
4,005 |
3,085 |
$229K |
| E1028 |
W/c manual swingaway |
2,397 |
1,289 |
$167K |
| E1002 |
Pwr seat tilt |
90 |
78 |
$133K |
| K0823 |
Pwc gp 2 std cap chair |
1,000 |
809 |
$118K |
| E2361 |
22nf sealed leadacid battery |
1,209 |
927 |
$108K |
| E2377 |
Expandable controller, initl |
712 |
514 |
$99K |
| E2313 |
Pwc harness, expand control |
677 |
493 |
$86K |
| E1223 |
Wheelchair spec size w foot |
96 |
80 |
$85K |
| E0955 |
Cushioned headrest |
1,110 |
811 |
$58K |
| K0842 |
Pwc gp2 std mult pow opt cap |
46 |
36 |
$51K |
| E1161 |
Manual adult wc w tiltinspac |
141 |
101 |
$18K |
| E0973 |
W/ch access det adj armrest |
577 |
303 |
$13K |
| K0108 |
W/c component-accessory nos |
380 |
187 |
$12K |
| K0821 |
Pwc gp 2 std port cap chair |
184 |
170 |
$12K |
| K0005 |
Ultralightweight wheelchair |
53 |
44 |
$12K |
| K0040 |
Adjustable angle footplate |
321 |
193 |
$8K |
| E0971 |
Wheelchair anti-tipping devi |
513 |
288 |
$8K |
| E2607 |
Skin pro/pos wc cus wd <22in |
113 |
84 |
$8K |
| E2611 |
Gen use back cush wdth <22in |
123 |
80 |
$5K |
| K0739 |
Repair/svc dme non-oxygen eq |
811 |
609 |
$4K |
| E2620 |
Wc planar back cush wd <22in |
41 |
26 |
$4K |
| E0978 |
W/c acc,saf belt pelv strap |
421 |
320 |
$3K |
| E2366 |
Battery charger, single mode |
72 |
55 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
33 |
13 |
$2K |
| E0961 |
Wheelchair brake extension |
234 |
129 |
$2K |
| E0951 |
Loop heel |
207 |
122 |
$1K |
| E2601 |
Gen w/c cushion wdth < 22 in |
65 |
50 |
$670.71 |
| K0019 |
Arm pad repl, each |
21 |
12 |
$93.26 |