| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0428 |
Bls |
347 |
210 |
$55K |
| A0429 |
Bls-emergency |
440 |
397 |
$53K |
| A0427 |
Als1-emergency |
440 |
409 |
$53K |
| E0601 |
Cont airway pressure device |
409 |
382 |
$31K |
| A0130 |
Noner transport wheelch van |
684 |
68 |
$24K |
| A0425 |
Ground mileage |
1,993 |
1,075 |
$15K |
| E0431 |
Portable gaseous 02 |
154 |
149 |
$10K |
| K0001 |
Standard wheelchair |
285 |
272 |
$9K |
| E1390 |
Oxygen concentrator |
176 |
168 |
$8K |
| E0143 |
Walker folding wheeled w/o s |
102 |
102 |
$8K |
| E0562 |
Humidifier heated used w pap |
444 |
421 |
$7K |
| E0443 |
Portable 02 contents, gas |
110 |
110 |
$7K |
| K0003 |
Lightweight wheelchair |
99 |
93 |
$6K |
| A0426 |
Als 1 |
30 |
29 |
$6K |
| J1100 |
Dexamethasone sodium phos |
49 |
45 |
$3K |
| E0570 |
Nebulizer with compression |
16 |
16 |
$1K |
| J1642 |
Inj heparin sodium per 10 u |
140 |
93 |
$856.68 |
| A7035 |
Pos airway press headgear |
69 |
68 |
$726.53 |
| J3490 |
Drugs unclassified injection |
185 |
102 |
$403.98 |
| A7038 |
Pos airway pressure filter |
59 |
58 |
$270.29 |
| A7037 |
Pos airway pressure tubing |
69 |
68 |
$221.48 |
| E0156 |
Walker seat attachment |
25 |
25 |
$99.89 |
| J7050 |
Normal saline solution infus |
95 |
70 |
$72.81 |
| J1200 |
Diphenhydramine hcl injectio |
30 |
28 |
$17.87 |
| A0380 |
Basic life support mileage |
362 |
37 |
$10.40 |
| A0999 |
Unlisted ambulance service |
224 |
180 |
$0.00 |
| A0398 |
Als routine disposble suppls |
78 |
74 |
$0.00 |
| S9379 |
Hit noc per diem |
26 |
26 |
$0.00 |
| A0424 |
Extra ambulance attendant |
225 |
214 |
$0.00 |
| T4541 |
Large disposable underpad |
129 |
129 |
$0.00 |
| A0422 |
Ambulance 02 life sustaining |
27 |
24 |
$0.00 |
| A7039 |
Filter, non disposable w pap |
26 |
25 |
$0.00 |