| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
652 |
576 |
$1.22M |
| K0108 |
W/c component-accessory nos |
848 |
694 |
$597K |
| E1028 |
W/c manual swingaway |
541 |
475 |
$167K |
| A9900 |
Supply/accessory/service |
1,136 |
951 |
$88K |
| E0973 |
W/ch access det adj armrest |
291 |
263 |
$55K |
| E0955 |
Cushioned headrest |
405 |
364 |
$50K |
| K0739 |
Repair/svc dme non-oxygen eq |
382 |
346 |
$31K |
| E0971 |
Wheelchair anti-tipping devi |
288 |
267 |
$14K |
| K0040 |
Adjustable angle footplate |
123 |
107 |
$11K |
| E0978 |
W/c acc,saf belt pelv strap |
269 |
246 |
$9K |
| E0950 |
Tray |
62 |
55 |
$8K |
| E0960 |
W/c shoulder harness/straps |
58 |
53 |
$4K |
| E2231 |
Solid seat support base |
50 |
38 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
12 |
12 |
$2K |