| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
3,268 |
3,049 |
$1.49M |
| E1007 |
Pwr seat combo w/shear |
175 |
165 |
$829K |
| K0108 |
W/c component-accessory nos |
2,577 |
1,232 |
$474K |
| E2311 |
Electro connect btw 2 sys |
465 |
440 |
$467K |
| E1028 |
W/c manual swingaway |
5,945 |
4,483 |
$372K |
| K0005 |
Ultralightweight wheelchair |
231 |
218 |
$358K |
| E2620 |
Wc planar back cush wd <22in |
798 |
756 |
$206K |
| E0973 |
W/ch access det adj armrest |
2,270 |
1,756 |
$181K |
| E0955 |
Cushioned headrest |
3,529 |
3,261 |
$174K |
| K0823 |
Pwc gp 2 std cap chair |
1,124 |
1,091 |
$173K |
| E1012 |
Ctr mount pwr elev leg rest |
484 |
450 |
$166K |
| E2607 |
Skin pro/pos wc cus wd <22in |
886 |
858 |
$159K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
41 |
41 |
$158K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,313 |
2,030 |
$130K |
| E2361 |
22nf sealed leadacid battery |
813 |
762 |
$95K |
| E2231 |
Solid seat support base |
817 |
771 |
$75K |
| E0971 |
Wheelchair anti-tipping devi |
1,592 |
1,250 |
$74K |
| E2377 |
Expandable controller, initl |
220 |
206 |
$55K |
| K0040 |
Adjustable angle footplate |
1,040 |
774 |
$55K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
130 |
128 |
$46K |
| E2313 |
Pwc harness, expand control |
234 |
217 |
$45K |
| E2615 |
Pos back post/lat wdth <22in |
110 |
103 |
$36K |
| E1002 |
Pwr seat tilt |
14 |
14 |
$28K |
| E2203 |
Frame depth less than 22 in |
25 |
25 |
$12K |
| E0951 |
Loop heel |
671 |
524 |
$12K |
| E2613 |
Position back cush wd <22in |
28 |
27 |
$9K |
| E0961 |
Wheelchair brake extension |
294 |
231 |
$9K |
| E2611 |
Gen use back cush wdth <22in |
90 |
80 |
$8K |
| E2363 |
Gr24 sealed leadacid battery |
37 |
34 |
$5K |
| E0990 |
Wheelchair elevating leg res |
26 |
26 |
$4K |
| K0195 |
Elevating whlchair leg rests |
449 |
421 |
$3K |
| E2624 |
Adj skin pro/pos cus<22in |
12 |
12 |
$3K |
| E2622 |
Adj skin pro w/c cus wd<22in |
15 |
14 |
$2K |
| K0004 |
High strength ltwt whlchr |
12 |
12 |
$2K |
| E0956 |
W/c lateral trunk/hip suppor |
13 |
12 |
$1K |
| E2365 |
U1 sealed leadacid battery |
15 |
14 |
$1K |
| K0019 |
Arm pad repl, each |
100 |
65 |
$876.76 |
| E0954 |
Foot box, any type each foot |
17 |
12 |
$779.31 |
| E0978 |
W/c acc,saf belt pelv strap |
13 |
12 |
$224.64 |
| K0039 |
Leg strap h style each |
14 |
13 |
$203.28 |
| E2601 |
Gen w/c cushion wdth < 22 in |
14 |
13 |
$187.81 |