| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
431 |
376 |
$172K |
| E0240 |
Bath/shower chair |
37 |
27 |
$91K |
| E1028 |
W/c manual swingaway |
234 |
143 |
$35K |
| E2617 |
Custom fab w/c back cushion |
27 |
27 |
$32K |
| K0739 |
Repair/svc dme non-oxygen eq |
275 |
262 |
$26K |
| E0973 |
W/ch access det adj armrest |
75 |
64 |
$12K |
| E2609 |
Custom fabricate w/c cushion |
13 |
13 |
$11K |
| E0956 |
W/c lateral trunk/hip suppor |
27 |
27 |
$7K |
| E0955 |
Cushioned headrest |
104 |
90 |
$6K |
| K0040 |
Adjustable angle footplate |
55 |
45 |
$6K |
| E1161 |
Manual adult wc w tiltinspac |
26 |
26 |
$4K |
| E0960 |
W/c shoulder harness/straps |
49 |
41 |
$4K |
| E0971 |
Wheelchair anti-tipping devi |
30 |
29 |
$2K |