| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2376 |
Power wheelchair accessory, expandable controller, including all related electronics and mounting hardware, replacement only |
1,959 |
617 |
$442K |
| E2370 |
Power wheelchair component, integrated drive wheel motor and gear box combination, replacement only |
1,728 |
729 |
$399K |
| E1007 |
Wheelchair accessory, power seating system, combination tilt and recline, with mechanical shear reduction |
171 |
161 |
$195K |
| E1010 |
Wheelchair accessory, addition to power seating system, power leg elevation system, including leg rest, pair |
434 |
191 |
$100K |
| E2363 |
Power wheelchair accessory, group 24 sealed lead acid battery, each (e.g., gel cell, absorbed glassmat) |
1,075 |
413 |
$66K |
| E2375 |
Power wheelchair accessory, non-expandable controller, including all related electronics and mounting hardware, replacement only |
334 |
272 |
$42K |
| E2369 |
Power wheelchair component, drive wheel gear box, replacement only |
286 |
266 |
$37K |
| E1016 |
Shock absorber for power wheelchair, each |
499 |
353 |
$19K |
| E2392 |
Power wheelchair accessory, solid (rubber/plastic) caster tire with integrated wheel, any size, replacement only, each |
562 |
401 |
$10K |
| E2387 |
Power wheelchair accessory, foam filled caster tire, any size, replacement only, each |
401 |
296 |
$8K |
| E2368 |
Power wheelchair component, drive wheel motor, replacement only |
25 |
24 |
$4K |
| E2396 |
Power wheelchair accessory, caster fork, any size, replacement only, each |
474 |
348 |
$3K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
2,878 |
956 |
$3K |
| A4554 |
Disposable underpads, all sizes |
24 |
24 |
$1K |
| A4335 |
Incontinence supply; miscellaneous |
24 |
24 |
$136.56 |