| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2370 |
Pwr wc dr wh motor/gear comb |
859 |
604 |
$115K |
| E2375 |
Non-expandable controller |
872 |
866 |
$112K |
| E2374 |
Hand/chin ctrl std joystick |
650 |
647 |
$63K |
| E2369 |
Pwr wc drivewheel gear repl |
302 |
270 |
$37K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,745 |
2,309 |
$31K |
| E2386 |
Foam filled drive wheel tire |
825 |
592 |
$23K |
| E2366 |
Battery charger, single mode |
753 |
745 |
$22K |
| E2392 |
Solid caster tire, integrate |
748 |
741 |
$17K |
| E2394 |
Drive wheel excludes tire |
823 |
589 |
$13K |
| E2368 |
Pwr wc drivewheel motor repl |
57 |
54 |
$8K |
| E2313 |
Pwc harness, expand control |
139 |
129 |
$8K |
| E0973 |
W/ch access det adj armrest |
300 |
224 |
$4K |
| K0462 |
Temporary replacement eqpmnt |
1,717 |
1,670 |
$3K |
| E1028 |
W/c manual swingaway |
46 |
46 |
$1K |
| E2361 |
22nf sealed leadacid battery |
29 |
29 |
$1K |
| E2395 |
Caster wheel excludes tire |
32 |
32 |
$947.32 |
| E2396 |
Caster fork |
47 |
45 |
$620.80 |
| E2387 |
Foam filled caster tire |
12 |
12 |
$323.59 |
| E2365 |
U1 sealed leadacid battery |
729 |
724 |
$135.22 |
| K0108 |
W/c component-accessory nos |
1,524 |
1,094 |
$87.60 |