| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
521 |
127 |
$278K |
| K0108 |
W/c component-accessory nos |
1,723 |
557 |
$237K |
| E1028 |
W/c manual swingaway |
1,153 |
757 |
$83K |
| K0739 |
Repair/svc dme non-oxygen eq |
865 |
776 |
$43K |
| E0955 |
Cushioned headrest |
516 |
489 |
$25K |
| E1161 |
Manual adult wc w tiltinspac |
36 |
36 |
$14K |
| E0973 |
W/ch access det adj armrest |
158 |
125 |
$11K |
| K0040 |
Adjustable angle footplate |
102 |
83 |
$6K |
| E0971 |
Wheelchair anti-tipping devi |
80 |
67 |
$3K |
| E2361 |
22nf sealed leadacid battery |
17 |
13 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
19 |
14 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
86 |
78 |
$1K |
| E0960 |
W/c shoulder harness/straps |
15 |
13 |
$854.51 |
| 97542 |
|
15 |
15 |
$297.00 |