| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0005 |
Ultralightweight wheelchair |
174 |
136 |
$254K |
| E1161 |
Manual adult wc w tiltinspac |
78 |
64 |
$139K |
| K0108 |
W/c component-accessory nos |
321 |
207 |
$83K |
| E0973 |
W/ch access det adj armrest |
613 |
355 |
$44K |
| E2613 |
Position back cush wd <22in |
141 |
116 |
$37K |
| E0971 |
Wheelchair anti-tipping devi |
560 |
330 |
$22K |
| E1028 |
W/c manual swingaway |
154 |
109 |
$18K |
| E0955 |
Cushioned headrest |
98 |
78 |
$11K |
| E0961 |
Wheelchair brake extension |
400 |
253 |
$11K |
| E2607 |
Skin pro/pos wc cus wd <22in |
29 |
29 |
$7K |
| E0951 |
Loop heel |
321 |
202 |
$5K |
| E2615 |
Pos back post/lat wdth <22in |
13 |
13 |
$5K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
22 |
14 |
$4K |
| E2603 |
Skin protect wc cus wd <22in |
35 |
31 |
$3K |
| K0040 |
Adjustable angle footplate |
42 |
25 |
$3K |
| E2231 |
Solid seat support base |
14 |
12 |
$2K |