| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult size wheelchair, includes tilt in space |
120 |
120 |
$5K |
| K0739 |
Repair or nonroutine service for durable medical equipment other than oxygen equipment requiring the skill of a technician, labor component, per 15 minutes |
54 |
53 |
$2K |
| E1028 |
Wheelchair accessory, manual swingaway, retractable or removable mounting hardware, other |
140 |
119 |
$1K |
| E0955 |
Wheelchair accessory, headrest, cushioned, any type, including fixed mounting hardware, each |
125 |
125 |
$647.46 |