| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1007 |
Pwr seat combo w/shear |
1,090 |
804 |
$2.87M |
| K0861 |
Pwc gp3 std mult pow opt s/b |
508 |
367 |
$1.32M |
| E2311 |
Electro connect btw 2 sys |
1,318 |
975 |
$998K |
| E1012 |
Ctr mount pwr elev leg rest |
1,219 |
887 |
$870K |
| K0823 |
Pwc gp 2 std cap chair |
2,718 |
2,242 |
$424K |
| E1028 |
W/c manual swingaway |
3,019 |
1,896 |
$288K |
| K0821 |
Pwc gp 2 std port cap chair |
2,384 |
1,929 |
$275K |
| K0005 |
Ultralightweight wheelchair |
299 |
232 |
$218K |
| E2361 |
22nf sealed leadacid battery |
1,813 |
1,300 |
$168K |
| E2377 |
Expandable controller, initl |
1,049 |
776 |
$149K |
| E1002 |
Pwr seat tilt |
153 |
108 |
$120K |
| E0955 |
Cushioned headrest |
1,839 |
1,370 |
$117K |
| K0825 |
Pwc gp 2 hd cap chair |
594 |
444 |
$109K |
| E2313 |
Pwc harness, expand control |
1,038 |
764 |
$108K |
| K0108 |
W/c component-accessory nos |
1,375 |
662 |
$75K |
| E2620 |
Wc planar back cush wd <22in |
177 |
120 |
$40K |
| E2365 |
U1 sealed leadacid battery |
631 |
491 |
$39K |
| E0973 |
W/ch access det adj armrest |
694 |
461 |
$34K |
| E1161 |
Manual adult wc w tiltinspac |
107 |
93 |
$25K |
| E2607 |
Skin pro/pos wc cus wd <22in |
168 |
117 |
$23K |
| K0835 |
Pwc gp2 std sing pow opt s/b |
21 |
16 |
$21K |
| E0277 |
Powered pres-redu air mattrs |
252 |
234 |
$20K |
| E0373 |
Nonpowered pressure mattress |
103 |
88 |
$16K |
| K0040 |
Adjustable angle footplate |
350 |
237 |
$15K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,111 |
845 |
$11K |
| E0971 |
Wheelchair anti-tipping devi |
422 |
288 |
$11K |
| K0842 |
Pwc gp2 std mult pow opt cap |
19 |
13 |
$8K |
| E2611 |
Gen use back cush wdth <22in |
61 |
50 |
$7K |
| E2603 |
Skin protect wc cus wd <22in |
105 |
72 |
$6K |
| E0261 |
Hosp bed semi-electr w/o mat |
214 |
182 |
$6K |
| K0816 |
Pwc gp 1 std cap chair |
57 |
49 |
$3K |
| E2211 |
Pneumatic propulsion tire |
128 |
90 |
$3K |
| E2366 |
Battery charger, single mode |
13 |
12 |
$1K |
| E0951 |
Loop heel |
151 |
93 |
$1K |
| E0978 |
W/c acc,saf belt pelv strap |
84 |
66 |
$1K |
| E2213 |
Pneumatic prop tire insert |
53 |
38 |
$947.24 |
| E2601 |
Gen w/c cushion wdth < 22 in |
29 |
26 |
$765.81 |
| E0260 |
Hosp bed semi-electr w/ matt |
13 |
13 |
$308.80 |
| K0195 |
Elevating whlchair leg rests |
81 |
65 |
$103.02 |
| E0961 |
Wheelchair brake extension |
16 |
12 |
$79.61 |