| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
2,070 |
926 |
$345K |
| E1028 |
W/c manual swingaway |
1,449 |
960 |
$90K |
| K0739 |
Repair/svc dme non-oxygen eq |
1,877 |
1,686 |
$82K |
| E1161 |
Manual adult wc w tiltinspac |
379 |
368 |
$77K |
| E0955 |
Cushioned headrest |
592 |
561 |
$30K |
| K0823 |
Pwc gp 2 std cap chair |
41 |
41 |
$15K |
| E0973 |
W/ch access det adj armrest |
63 |
44 |
$5K |
| E0971 |
Wheelchair anti-tipping devi |
44 |
39 |
$2K |
| E2213 |
Pneumatic prop tire insert |
31 |
28 |
$1K |
| E0978 |
W/c acc,saf belt pelv strap |
42 |
39 |
$953.45 |
| E2211 |
Pneumatic propulsion tire |
16 |
14 |
$849.16 |
| E0961 |
Wheelchair brake extension |
13 |
12 |
$607.41 |