| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
5,890 |
1,770 |
$663K |
| E1399 |
Durable medical equipment mi |
1,910 |
448 |
$501K |
| E1028 |
W/c manual swingaway |
5,059 |
2,179 |
$337K |
| E0955 |
Cushioned headrest |
1,983 |
1,316 |
$131K |
| E1161 |
Manual adult wc w tiltinspac |
213 |
170 |
$110K |
| E0973 |
W/ch access det adj armrest |
1,747 |
1,023 |
$89K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,245 |
2,024 |
$88K |
| K0823 |
Pwc gp 2 std cap chair |
629 |
434 |
$74K |
| K0040 |
Adjustable angle footplate |
1,055 |
607 |
$67K |
| E0971 |
Wheelchair anti-tipping devi |
657 |
397 |
$26K |
| E0956 |
W/c lateral trunk/hip suppor |
203 |
87 |
$22K |
| E0960 |
W/c shoulder harness/straps |
305 |
195 |
$17K |
| E0978 |
W/c acc,saf belt pelv strap |
858 |
540 |
$15K |
| E2361 |
22nf sealed leadacid battery |
83 |
51 |
$6K |
| E2213 |
Pneumatic prop tire insert |
163 |
101 |
$3K |
| E0951 |
Loop heel |
169 |
92 |
$3K |
| E0630 |
Patient lift hydraulic |
34 |
25 |
$2K |
| E2365 |
U1 sealed leadacid battery |
41 |
25 |
$1K |
| E0950 |
Tray |
15 |
12 |
$843.93 |
| E2211 |
Pneumatic propulsion tire |
19 |
12 |
$406.90 |