| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0739 |
Repair/svc dme non-oxygen eq |
2,169 |
1,477 |
$57K |
| E2370 |
Pwr wc dr wh motor/gear comb |
23 |
12 |
$2K |
| K0462 |
Temporary replacement eqpmnt |
25 |
24 |
$1K |
| E2395 |
Caster wheel excludes tire |
87 |
25 |
$1K |
| K0108 |
W/c component-accessory nos |
13 |
12 |
$967.46 |
| E2387 |
Foam filled caster tire |
39 |
12 |
$957.18 |
| K0001 |
Standard wheelchair |
68 |
68 |
$466.51 |
| K0003 |
Lightweight wheelchair |
54 |
54 |
$359.81 |
| E2366 |
Battery charger, single mode |
12 |
12 |
$338.39 |
| K0002 |
Stnd hemi (low seat) whlchr |
40 |
40 |
$314.97 |
| E2394 |
Drive wheel excludes tire |
24 |
12 |
$284.86 |
| E0156 |
Walker seat attachment |
24 |
24 |
$87.24 |