| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
2,478 |
1,369 |
$620K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,816 |
2,581 |
$461K |
| E2361 |
22nf sealed leadacid battery |
1,222 |
1,163 |
$402K |
| K0823 |
Pwc gp 2 std cap chair |
76 |
64 |
$372K |
| E1007 |
Pwr seat combo w/shear |
25 |
25 |
$260K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
13 |
13 |
$114K |
| E0973 |
W/ch access det adj armrest |
522 |
450 |
$79K |
| E2311 |
Electro connect btw 2 sys |
28 |
28 |
$77K |
| E2374 |
Hand/chin ctrl std joystick |
73 |
73 |
$67K |
| E1028 |
W/c manual swingaway |
236 |
173 |
$66K |
| E2394 |
Drive wheel excludes tire |
312 |
259 |
$52K |
| E2395 |
Caster wheel excludes tire |
172 |
160 |
$46K |
| E2386 |
Foam filled drive wheel tire |
120 |
107 |
$38K |
| E2366 |
Battery charger, single mode |
107 |
99 |
$33K |
| E2389 |
Foam caster tire |
157 |
143 |
$23K |
| E1012 |
Ctr mount pwr elev leg rest |
12 |
12 |
$19K |
| E2377 |
Expandable controller, initl |
25 |
25 |
$14K |
| E0955 |
Cushioned headrest |
63 |
63 |
$11K |
| E2313 |
Pwc harness, expand control |
24 |
24 |
$9K |
| E2620 |
Wc planar back cush wd <22in |
13 |
13 |
$8K |
| E2210 |
Wheelchair bearings |
229 |
197 |
$8K |
| E2365 |
U1 sealed leadacid battery |
27 |
26 |
$7K |
| K0019 |
Arm pad repl, each |
42 |
40 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
107 |
80 |
$607.92 |
| E0971 |
Wheelchair anti-tipping devi |
38 |
24 |
$273.42 |