| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1007 |
Pwr seat combo w/shear |
3,348 |
2,304 |
$9.04M |
| E2311 |
Electro connect btw 2 sys |
3,922 |
2,735 |
$2.94M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
1,164 |
775 |
$2.50M |
| E1012 |
Ctr mount pwr elev leg rest |
21,231 |
15,405 |
$901K |
| E1028 |
W/c manual swingaway |
8,707 |
4,256 |
$625K |
| K0823 |
Pwc gp 2 std cap chair |
6,458 |
5,355 |
$569K |
| K0842 |
Pwc gp2 std mult pow opt cap |
793 |
536 |
$558K |
| K0821 |
Pwc gp 2 std port cap chair |
7,615 |
6,601 |
$513K |
| E1002 |
Pwr seat tilt |
300 |
228 |
$438K |
| E2377 |
Expandable controller, initl |
3,328 |
2,286 |
$409K |
| E2361 |
22nf sealed leadacid battery |
5,217 |
3,344 |
$370K |
| E1223 |
Wheelchair spec size w foot |
437 |
365 |
$328K |
| K0825 |
Pwc gp 2 hd cap chair |
2,455 |
2,123 |
$302K |
| E0955 |
Cushioned headrest |
4,168 |
2,956 |
$229K |
| E2620 |
Wc planar back cush wd <22in |
990 |
652 |
$165K |
| E2313 |
Pwc harness, expand control |
2,144 |
1,498 |
$84K |
| E2607 |
Skin pro/pos wc cus wd <22in |
1,035 |
650 |
$80K |
| E2365 |
U1 sealed leadacid battery |
2,051 |
1,468 |
$79K |
| K0108 |
W/c component-accessory nos |
1,362 |
686 |
$51K |
| E0973 |
W/ch access det adj armrest |
1,582 |
861 |
$45K |
| E2611 |
Gen use back cush wdth <22in |
714 |
476 |
$30K |
| K0040 |
Adjustable angle footplate |
1,065 |
565 |
$25K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,486 |
2,560 |
$20K |
| E1399 |
Durable medical equipment mi |
429 |
230 |
$20K |
| E0971 |
Wheelchair anti-tipping devi |
1,144 |
630 |
$19K |
| E1161 |
Manual adult wc w tiltinspac |
456 |
403 |
$18K |
| E2366 |
Battery charger, single mode |
306 |
238 |
$14K |
| E2374 |
Hand/chin ctrl std joystick |
65 |
55 |
$11K |
| K0005 |
Ultralightweight wheelchair |
90 |
66 |
$8K |
| E2363 |
Gr24 sealed leadacid battery |
51 |
28 |
$7K |
| E2601 |
Gen w/c cushion wdth < 22 in |
500 |
325 |
$7K |
| E0978 |
W/c acc,saf belt pelv strap |
1,053 |
728 |
$7K |
| E2608 |
Skin pro/pos wc cus wd>=22in |
52 |
27 |
$6K |
| E2621 |
Wc planar back cush wd>=22in |
22 |
13 |
$5K |
| E0951 |
Loop heel |
729 |
383 |
$3K |
| E1240 |
Whchr litwt det arm leg rest |
292 |
274 |
$3K |
| E2603 |
Skin protect wc cus wd <22in |
39 |
31 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
72 |
27 |
$2K |
| E0961 |
Wheelchair brake extension |
402 |
217 |
$2K |
| E0953 |
W/c lateral thigh/knee sup |
90 |
38 |
$2K |
| E1090 |
Wheelchair lightweight det a |
205 |
199 |
$2K |
| E2386 |
Foam filled drive wheel tire |
16 |
12 |
$1K |
| E1020 |
Residual limb support system |
25 |
24 |
$604.05 |
| K0195 |
Elevating whlchair leg rests |
736 |
635 |
$495.49 |
| E1295 |
Wheelchair heavy duty fixed |
26 |
25 |
$465.79 |
| E2392 |
Solid caster tire, integrate |
25 |
12 |
$332.96 |
| K0019 |
Arm pad repl, each |
35 |
25 |
$241.22 |
| K0003 |
Lightweight wheelchair |
373 |
340 |
$151.34 |
| K0004 |
High strength ltwt whlchr |
208 |
204 |
$140.30 |
| K0001 |
Standard wheelchair |
13 |
12 |
$0.00 |