| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1007 |
Pwr seat combo w/shear |
732 |
540 |
$642K |
| K0823 |
Pwc gp 2 std cap chair |
3,449 |
2,966 |
$253K |
| E2311 |
Electro connect btw 2 sys |
859 |
639 |
$219K |
| K0108 |
W/c component-accessory nos |
190 |
117 |
$183K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
104 |
81 |
$167K |
| E1012 |
Ctr mount pwr elev leg rest |
738 |
535 |
$81K |
| E2361 |
22nf sealed leadacid battery |
1,084 |
829 |
$58K |
| E1028 |
W/c manual swingaway |
2,786 |
1,524 |
$58K |
| K0821 |
Pwc gp 2 std port cap chair |
661 |
617 |
$57K |
| K0005 |
Ultralightweight wheelchair |
59 |
39 |
$50K |
| E2377 |
Expandable controller, initl |
710 |
526 |
$40K |
| E2313 |
Pwc harness, expand control |
682 |
500 |
$23K |
| E0955 |
Cushioned headrest |
1,331 |
975 |
$19K |
| K0825 |
Pwc gp 2 hd cap chair |
71 |
62 |
$9K |
| E0973 |
W/ch access det adj armrest |
166 |
106 |
$8K |
| E2620 |
Wc planar back cush wd <22in |
54 |
42 |
$6K |
| E0971 |
Wheelchair anti-tipping devi |
136 |
89 |
$4K |
| K0800 |
Pov group 1 std up to 300lbs |
13 |
13 |
$3K |
| E2365 |
U1 sealed leadacid battery |
55 |
50 |
$2K |
| E2603 |
Skin protect wc cus wd <22in |
59 |
43 |
$2K |
| K0739 |
Repair/svc dme non-oxygen eq |
240 |
209 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
109 |
84 |
$1K |
| K0195 |
Elevating whlchair leg rests |
326 |
258 |
$970.71 |
| E0951 |
Loop heel |
86 |
52 |
$955.60 |
| E0961 |
Wheelchair brake extension |
18 |
12 |
$427.96 |
| E2366 |
Battery charger, single mode |
14 |
12 |
$383.52 |
| K0733 |
12-24hr sealed lead acid |
27 |
27 |
$295.89 |
| E1161 |
Manual adult wc w tiltinspac |
12 |
12 |
$277.74 |