| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1161 |
Manual adult wc w tiltinspac |
3,508 |
3,240 |
$654K |
| K0108 |
W/c component-accessory nos |
2,135 |
1,600 |
$534K |
| E1028 |
W/c manual swingaway |
5,300 |
4,604 |
$350K |
| K0823 |
Pwc gp 2 std cap chair |
567 |
509 |
$169K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,840 |
2,494 |
$141K |
| E0955 |
Cushioned headrest |
4,086 |
3,698 |
$129K |
| E0973 |
W/ch access det adj armrest |
1,098 |
792 |
$111K |
| K0040 |
Adjustable angle footplate |
681 |
506 |
$45K |
| E0971 |
Wheelchair anti-tipping devi |
540 |
417 |
$23K |
| E0978 |
W/c acc,saf belt pelv strap |
751 |
634 |
$22K |
| E2211 |
Pneumatic propulsion tire |
247 |
178 |
$9K |
| E0960 |
W/c shoulder harness/straps |
142 |
113 |
$8K |
| K0019 |
Arm pad repl, each |
278 |
217 |
$6K |
| E0951 |
Loop heel |
303 |
203 |
$5K |
| E2607 |
Skin pro/pos wc cus wd <22in |
26 |
24 |
$4K |
| E2231 |
Solid seat support base |
51 |
51 |
$3K |
| E2213 |
Pneumatic prop tire insert |
140 |
102 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
19 |
13 |
$3K |
| E0961 |
Wheelchair brake extension |
80 |
55 |
$2K |
| K0195 |
Elevating whlchair leg rests |
485 |
485 |
$2K |
| K0004 |
High strength ltwt whlchr |
27 |
24 |
$462.97 |