| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
4,340 |
4,322 |
$553K |
| K0108 |
W/c component-accessory nos |
1,645 |
1,212 |
$220K |
| K0823 |
Pwc gp 2 std cap chair |
383 |
381 |
$153K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,643 |
3,462 |
$144K |
| E0955 |
Cushioned headrest |
4,966 |
4,935 |
$85K |
| E1028 |
W/c manual swingaway |
7,166 |
5,714 |
$77K |
| E2617 |
Custom fab w/c back cushion |
86 |
85 |
$64K |
| K0040 |
Adjustable angle footplate |
1,340 |
893 |
$48K |
| E0971 |
Wheelchair anti-tipping devi |
1,332 |
848 |
$23K |
| E2609 |
Custom fabricate w/c cushion |
27 |
27 |
$23K |
| E2607 |
Skin pro/pos wc cus wd <22in |
158 |
157 |
$18K |
| E2213 |
Pneumatic prop tire insert |
1,049 |
674 |
$18K |
| E0960 |
W/c shoulder harness/straps |
373 |
369 |
$16K |
| E0973 |
W/ch access det adj armrest |
1,095 |
669 |
$14K |
| E2361 |
22nf sealed leadacid battery |
124 |
123 |
$11K |
| E2211 |
Pneumatic propulsion tire |
943 |
606 |
$9K |
| E0951 |
Loop heel |
1,013 |
637 |
$8K |
| E2620 |
Wc planar back cush wd <22in |
29 |
29 |
$6K |
| E0978 |
W/c acc,saf belt pelv strap |
728 |
721 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
29 |
20 |
$2K |
| E2231 |
Solid seat support base |
70 |
69 |
$2K |
| E2206 |
Man wc whl lock comp repl ea |
65 |
39 |
$848.28 |
| E0952 |
Toe loop/holder, each |
16 |
12 |
$256.13 |
| K0019 |
Arm pad repl, each |
47 |
29 |
$111.30 |
| A9270 |
Non-covered item or service |
90 |
90 |
$0.00 |