| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
8,120 |
4,352 |
$1.17M |
| K0739 |
Repair/svc dme non-oxygen eq |
7,638 |
6,903 |
$888K |
| E1028 |
W/c manual swingaway |
3,330 |
2,788 |
$325K |
| E1399 |
Durable medical equipment mi |
651 |
278 |
$255K |
| E1161 |
Manual adult wc w tiltinspac |
508 |
490 |
$178K |
| E0955 |
Cushioned headrest |
1,443 |
1,373 |
$103K |
| E0973 |
W/ch access det adj armrest |
1,121 |
931 |
$95K |
| E2361 |
22nf sealed leadacid battery |
544 |
501 |
$75K |
| K0823 |
Pwc gp 2 std cap chair |
270 |
255 |
$67K |
| E2622 |
Adj skin pro w/c cus wd<22in |
320 |
292 |
$55K |
| K0005 |
Ultralightweight wheelchair |
41 |
40 |
$37K |
| E2607 |
Skin pro/pos wc cus wd <22in |
227 |
216 |
$35K |
| E0971 |
Wheelchair anti-tipping devi |
546 |
441 |
$22K |
| K0040 |
Adjustable angle footplate |
380 |
318 |
$22K |
| E0978 |
W/c acc,saf belt pelv strap |
920 |
848 |
$18K |
| E0956 |
W/c lateral trunk/hip suppor |
48 |
37 |
$6K |
| K0019 |
Arm pad repl, each |
347 |
326 |
$5K |
| E2374 |
Hand/chin ctrl std joystick |
17 |
13 |
$3K |
| E2211 |
Pneumatic propulsion tire |
65 |
57 |
$3K |
| E0951 |
Loop heel |
114 |
93 |
$2K |
| E2366 |
Battery charger, single mode |
24 |
24 |
$2K |
| E2620 |
Wc planar back cush wd <22in |
12 |
12 |
$2K |
| E2394 |
Drive wheel excludes tire |
32 |
29 |
$2K |
| E2365 |
U1 sealed leadacid battery |
13 |
13 |
$2K |
| E2395 |
Caster wheel excludes tire |
26 |
25 |
$2K |
| E2392 |
Solid caster tire, integrate |
24 |
24 |
$1K |
| E0960 |
W/c shoulder harness/straps |
15 |
14 |
$1K |
| E2210 |
Wheelchair bearings |
15 |
15 |
$146.22 |