| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E2617 |
Custom fab w/c back cushion |
3,186 |
2,836 |
$4.70M |
| E2609 |
Custom fabricate w/c cushion |
3,321 |
2,946 |
$3.79M |
| E1161 |
Manual adult wc w tiltinspac |
1,559 |
1,321 |
$2.13M |
| K0005 |
Ultralightweight wheelchair |
814 |
697 |
$1.28M |
| K0108 |
W/c component-accessory nos |
3,883 |
2,867 |
$1.20M |
| E1007 |
Pwr seat combo w/shear |
164 |
134 |
$793K |
| E1028 |
W/c manual swingaway |
4,339 |
3,180 |
$778K |
| E0973 |
W/ch access det adj armrest |
2,678 |
2,186 |
$356K |
| E2311 |
Electro connect btw 2 sys |
247 |
204 |
$350K |
| E0955 |
Cushioned headrest |
2,580 |
2,213 |
$349K |
| E0990 |
Wheelchair elevating leg res |
1,908 |
1,634 |
$294K |
| K0040 |
Adjustable angle footplate |
2,309 |
1,910 |
$250K |
| E2203 |
Frame depth less than 22 in |
619 |
530 |
$229K |
| E0956 |
W/c lateral trunk/hip suppor |
1,396 |
1,148 |
$221K |
| K0861 |
Pwc gp3 std mult pow opt s/b |
44 |
38 |
$178K |
| E1225 |
Manual semi-reclining back |
1,000 |
863 |
$167K |
| E0971 |
Wheelchair anti-tipping devi |
2,417 |
2,012 |
$158K |
| E2201 |
Man w/ch acc seat w>=20"<24" |
489 |
425 |
$141K |
| E2231 |
Solid seat support base |
1,130 |
981 |
$138K |
| E0954 |
Foot box, any type each foot |
484 |
339 |
$72K |
| E2377 |
Expandable controller, initl |
223 |
192 |
$63K |
| E1012 |
Ctr mount pwr elev leg rest |
51 |
42 |
$63K |
| E0961 |
Wheelchair brake extension |
1,651 |
1,355 |
$59K |
| K0739 |
Repair/svc dme non-oxygen eq |
2,601 |
2,244 |
$57K |
| E2211 |
Pneumatic propulsion tire |
1,173 |
940 |
$50K |
| E2313 |
Pwc harness, expand control |
220 |
190 |
$48K |
| E0978 |
W/c acc,saf belt pelv strap |
1,286 |
1,121 |
$41K |
| E2361 |
22nf sealed leadacid battery |
232 |
204 |
$41K |
| E2213 |
Pneumatic prop tire insert |
857 |
736 |
$41K |
| K0823 |
Pwc gp 2 std cap chair |
248 |
223 |
$21K |
| E0951 |
Loop heel |
449 |
219 |
$6K |
| E2363 |
Gr24 sealed leadacid battery |
14 |
12 |
$3K |
| E2206 |
Man wc whl lock comp repl ea |
15 |
13 |
$203.20 |
| K0195 |
Elevating whlchair leg rests |
56 |
50 |
$150.81 |