| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
401 |
324 |
$1.15M |
| K0108 |
W/c component-accessory nos |
953 |
692 |
$258K |
| K0823 |
Pwc gp 2 std cap chair |
583 |
571 |
$178K |
| E1028 |
W/c manual swingaway |
485 |
396 |
$39K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,698 |
1,556 |
$25K |
| E1161 |
Manual adult wc w tiltinspac |
249 |
241 |
$25K |
| E0973 |
W/ch access det adj armrest |
375 |
304 |
$16K |
| E0955 |
Cushioned headrest |
219 |
207 |
$9K |
| E1236 |
Folding ped wc adjustable |
17 |
14 |
$8K |
| K0825 |
Pwc gp 2 hd cap chair |
12 |
12 |
$8K |
| E0260 |
Hosp bed semi-electr w/ matt |
66 |
66 |
$3K |
| E2365 |
U1 sealed leadacid battery |
27 |
27 |
$1K |
| E0960 |
W/c shoulder harness/straps |
14 |
14 |
$1K |
| E0978 |
W/c acc,saf belt pelv strap |
31 |
26 |
$758.35 |
| K0040 |
Adjustable angle footplate |
20 |
14 |
$404.38 |