| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1007 |
Pwr seat combo w/shear |
35 |
28 |
$68K |
| E1028 |
W/c manual swingaway |
492 |
324 |
$38K |
| E1012 |
Ctr mount pwr elev leg rest |
43 |
32 |
$29K |
| E2311 |
Electro connect btw 2 sys |
44 |
33 |
$26K |
| E2361 |
22nf sealed leadacid battery |
317 |
249 |
$23K |
| K0823 |
Pwc gp 2 std cap chair |
427 |
345 |
$19K |
| E0955 |
Cushioned headrest |
127 |
103 |
$9K |
| E2377 |
Expandable controller, initl |
36 |
28 |
$3K |
| E2313 |
Pwc harness, expand control |
36 |
28 |
$3K |
| K0739 |
Repair/svc dme non-oxygen eq |
275 |
220 |
$2K |
| K0821 |
Pwc gp 2 std port cap chair |
14 |
12 |
$2K |
| K0108 |
W/c component-accessory nos |
155 |
87 |
$2K |