| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
71 |
60 |
$192K |
| E1161 |
Manual adult wc w tiltinspac |
1,280 |
977 |
$26K |
| K0108 |
W/c component-accessory nos |
79 |
33 |
$12K |
| E1028 |
W/c manual swingaway |
4,200 |
1,455 |
$8K |
| E0951 |
Loop heel |
1,714 |
720 |
$5K |
| E0955 |
Cushioned headrest |
1,534 |
1,164 |
$3K |
| E0973 |
W/ch access det adj armrest |
2,280 |
965 |
$2K |
| E0971 |
Wheelchair anti-tipping devi |
2,143 |
917 |
$1K |
| K0195 |
Elevating whlchair leg rests |
58 |
40 |
$546.06 |
| K0739 |
Repair/svc dme non-oxygen eq |
94 |
70 |
$406.86 |
| K0040 |
Adjustable angle footplate |
386 |
193 |
$370.45 |
| E2203 |
Frame depth less than 22 in |
62 |
38 |
$9.13 |