| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0005 |
Ultralightweight wheelchair |
12 |
12 |
$6K |
| E0973 |
Wheelchair accessory, adjustable height, detachable armrest, complete assembly, each |
24 |
12 |
$513.52 |
| E0971 |
Manual wheelchair accessory, anti-tipping device, each |
24 |
12 |
$267.34 |
| E0961 |
Manual wheelchair accessory, wheel lock brake extension (handle), each |
24 |
12 |
$175.54 |
| E2218 |
Manual wheelchair accessory, foam propulsion tire, any size, each |
26 |
13 |
$108.20 |
| E0951 |
Heel loop/holder, any type, with or without ankle strap, each |
24 |
12 |
$102.62 |
| E0978 |
Wheelchair accessory, positioning belt/safety belt/pelvic strap, each |
12 |
12 |
$83.17 |