| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2376 |
Expandable controller, repl |
1,959 |
617 |
$442K |
| E2370 |
Pwr wc dr wh motor/gear comb |
1,728 |
729 |
$399K |
| E1007 |
Pwr seat combo w/shear |
171 |
161 |
$195K |
| E1010 |
Add pwr leg elevation |
434 |
191 |
$100K |
| E2363 |
Gr24 sealed leadacid battery |
1,075 |
413 |
$66K |
| E2375 |
Non-expandable controller |
334 |
272 |
$42K |
| E2369 |
Pwr wc drivewheel gear repl |
286 |
266 |
$37K |
| E1016 |
Shock absorber for power w/c |
499 |
353 |
$19K |
| E2392 |
Solid caster tire, integrate |
562 |
401 |
$10K |
| E2387 |
Foam filled caster tire |
401 |
296 |
$8K |
| E2368 |
Pwr wc drivewheel motor repl |
25 |
24 |
$4K |
| E2396 |
Caster fork |
474 |
348 |
$3K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,878 |
956 |
$3K |
| A4554 |
Disposable underpads |
24 |
24 |
$1K |
| A4335 |
Incontinence supply |
24 |
24 |
$136.56 |