| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| K0108 |
W/c component-accessory nos |
4,395 |
1,890 |
$361K |
| E1028 |
W/c manual swingaway |
5,686 |
3,399 |
$212K |
| S5165 |
Home modifications per serv |
253 |
183 |
$175K |
| E1161 |
Manual adult wc w tiltinspac |
2,092 |
1,824 |
$139K |
| K0739 |
Repair/svc dme non-oxygen eq |
3,750 |
3,194 |
$66K |
| E0955 |
Cushioned headrest |
2,423 |
2,215 |
$53K |
| K0823 |
Pwc gp 2 std cap chair |
517 |
442 |
$52K |
| E0973 |
W/ch access det adj armrest |
1,433 |
916 |
$51K |
| K0004 |
High strength ltwt whlchr |
1,912 |
1,790 |
$18K |
| K0800 |
Pov group 1 std up to 300lbs |
70 |
65 |
$17K |
| E2607 |
Skin pro/pos wc cus wd <22in |
125 |
114 |
$11K |
| K0040 |
Adjustable angle footplate |
271 |
186 |
$11K |
| E0277 |
Powered pres-redu air mattrs |
91 |
81 |
$11K |
| E0971 |
Wheelchair anti-tipping devi |
424 |
281 |
$9K |
| K0007 |
Extra heavy duty wheelchair |
157 |
94 |
$5K |
| E0260 |
Hosp bed semi-electr w/ matt |
108 |
105 |
$3K |
| E0956 |
W/c lateral trunk/hip suppor |
83 |
40 |
$3K |
| E2361 |
22nf sealed leadacid battery |
32 |
28 |
$2K |
| E0978 |
W/c acc,saf belt pelv strap |
120 |
104 |
$2K |
| E0630 |
Patient lift hydraulic |
39 |
37 |
$2K |
| E2611 |
Gen use back cush wdth <22in |
29 |
26 |
$1K |
| K0195 |
Elevating whlchair leg rests |
368 |
361 |
$421.39 |
| E0961 |
Wheelchair brake extension |
72 |
42 |
$385.97 |
| K0019 |
Arm pad repl, each |
82 |
49 |
$299.58 |
| E0951 |
Loop heel |
44 |
25 |
$258.89 |
| E0261 |
Hosp bed semi-electr w/o mat |
14 |
12 |
$254.10 |
| K0001 |
Standard wheelchair |
228 |
228 |
$0.00 |