| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2617 |
Custom fab w/c back cushion |
2,258 |
1,442 |
$1.31M |
| E1161 |
Manual adult wc w tiltinspac |
3,422 |
2,903 |
$1.25M |
| E2609 |
Custom fabricate w/c cushion |
2,424 |
1,513 |
$1.07M |
| K0108 |
W/c component-accessory nos |
4,787 |
2,132 |
$944K |
| E1399 |
Durable medical equipment mi |
1,339 |
287 |
$887K |
| E1028 |
W/c manual swingaway |
7,701 |
4,344 |
$605K |
| E0955 |
Cushioned headrest |
4,642 |
3,795 |
$232K |
| E0973 |
W/ch access det adj armrest |
2,621 |
1,578 |
$218K |
| K0040 |
Adjustable angle footplate |
2,378 |
1,493 |
$165K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,274 |
2,349 |
$154K |
| E0956 |
W/c lateral trunk/hip suppor |
984 |
538 |
$116K |
| E0971 |
Wheelchair anti-tipping devi |
1,931 |
1,170 |
$80K |
| E0960 |
W/c shoulder harness/straps |
847 |
684 |
$55K |
| K0005 |
Ultralightweight wheelchair |
22 |
16 |
$27K |
| E0951 |
Loop heel |
2,083 |
894 |
$27K |
| E2361 |
22nf sealed leadacid battery |
159 |
118 |
$26K |
| E0978 |
W/c acc,saf belt pelv strap |
796 |
636 |
$22K |
| E2231 |
Solid seat support base |
324 |
190 |
$20K |
| E0240 |
Bath/shower chair |
14 |
13 |
$16K |
| K0823 |
Pwc gp 2 std cap chair |
15 |
12 |
$13K |
| E2607 |
Skin pro/pos wc cus wd <22in |
40 |
36 |
$11K |
| E0950 |
Tray |
97 |
77 |
$10K |
| E0990 |
Wheelchair elevating leg res |
68 |
41 |
$5K |
| E2213 |
Pneumatic prop tire insert |
126 |
95 |
$5K |
| E0961 |
Wheelchair brake extension |
164 |
98 |
$4K |
| E2211 |
Pneumatic propulsion tire |
53 |
25 |
$832.28 |
| K0019 |
Arm pad repl, each |
49 |
38 |
$630.43 |
| K0195 |
Elevating whlchair leg rests |
13 |
12 |
$36.14 |