| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99284 |
|
3,576 |
2,922 |
$242K |
| 99283 |
|
4,593 |
3,918 |
$228K |
| 99282 |
|
2,162 |
1,959 |
$59K |
| 99285 |
|
340 |
219 |
$25K |
| A0430 |
Fixed wing air transport |
22 |
22 |
$20K |
| 99213 |
|
837 |
681 |
$17K |
| G0463 |
Hospital outpt clinic visit |
1,453 |
612 |
$17K |
| 99214 |
|
575 |
414 |
$15K |
| A0435 |
Fixed wing air mileage |
22 |
22 |
$12K |
| E1390 |
Oxygen concentrator |
278 |
277 |
$11K |
| 90999 |
|
699 |
17 |
$10K |
| A0427 |
Als1-emergency |
104 |
88 |
$8K |
| 93010 |
|
1,317 |
1,068 |
$7K |
| A0429 |
Bls-emergency |
76 |
71 |
$6K |
| 93005 |
|
572 |
65 |
$5K |
| 99232 |
|
342 |
103 |
$5K |
| A0425 |
Ground mileage |
234 |
210 |
$5K |
| G0008 |
Admin influenza virus vac |
310 |
46 |
$4K |
| 01967 |
|
13 |
12 |
$4K |
| 99212 |
|
126 |
107 |
$4K |
| J3301 |
Triamcinolone acet inj nos |
73 |
24 |
$3K |
| 97110 |
|
218 |
70 |
$3K |
| 99309 |
|
149 |
129 |
$3K |
| 96372 |
|
33 |
14 |
$3K |
| 99308 |
|
192 |
170 |
$3K |
| 00170 |
|
12 |
12 |
$2K |
| A9270 |
Non-covered item or service |
161 |
22 |
$2K |
| E0601 |
Cont airway pressure device |
58 |
58 |
$1K |
| 98941 |
|
80 |
65 |
$1K |
| 99223 |
Prolong inpt eval add15 m |
33 |
28 |
$1K |
| A7030 |
Cpap full face mask |
48 |
48 |
$1K |
| A7031 |
Replacement facemask interfa |
47 |
47 |
$1K |
| 90863 |
|
58 |
56 |
$1K |
| 99281 |
|
13 |
12 |
$1K |
| E1392 |
Portable oxygen concentrator |
61 |
61 |
$984.08 |
| 97161 |
|
53 |
13 |
$821.29 |
| 71046 |
|
80 |
64 |
$780.05 |
| G2025 |
Dis site tele svcs rhc/fqhc |
41 |
38 |
$739.00 |
| 99215 |
Prolong outpt/office vis |
31 |
25 |
$722.30 |
| A4604 |
Tubing with heating element |
66 |
66 |
$631.16 |
| 92014 |
|
30 |
29 |
$600.05 |
| K0738 |
Portable gas oxygen system |
15 |
15 |
$517.60 |
| E0431 |
Portable gaseous 02 |
58 |
58 |
$512.47 |
| Q3014 |
Telehealth facility fee |
40 |
33 |
$454.14 |
| 71045 |
|
150 |
96 |
$446.62 |
| J7626 |
Budesonide non-comp unit |
26 |
26 |
$402.27 |
| 90834 |
|
26 |
25 |
$396.04 |
| 99203 |
|
16 |
16 |
$390.00 |
| 99238 |
|
26 |
26 |
$367.34 |
| Q0513 |
Disp fee inhal drugs/30 days |
61 |
59 |
$336.60 |
| 97140 |
|
61 |
16 |
$319.59 |
| 99239 |
|
18 |
17 |
$315.76 |
| A4253 |
Blood glucose/reagent strips |
105 |
101 |
$287.90 |
| A7038 |
Pos airway pressure filter |
78 |
78 |
$266.19 |
| 88305 |
|
18 |
18 |
$264.47 |
| E0570 |
Nebulizer with compression |
68 |
68 |
$256.88 |
| 99231 |
|
34 |
14 |
$235.72 |
| A7034 |
Nasal application device |
14 |
14 |
$211.67 |
| A7035 |
Pos airway press headgear |
36 |
36 |
$179.40 |
| 99442 |
|
15 |
15 |
$166.58 |
| 99307 |
|
12 |
12 |
$118.49 |
| 93296 |
|
14 |
14 |
$94.70 |
| A7046 |
Repl water chamber, pap dev |
34 |
34 |
$94.62 |
| K0001 |
Standard wheelchair |
12 |
12 |
$74.36 |
| J7620 |
Albuterol ipratrop non-comp |
31 |
30 |
$68.50 |
| E0562 |
Humidifier heated used w pap |
14 |
14 |
$59.47 |
| A4357 |
Bedside drainage bag |
17 |
16 |
$54.11 |
| J7613 |
Albuterol non-comp unit |
12 |
12 |
$14.05 |
| A4259 |
Lancets per box |
14 |
13 |
$3.08 |
| 36415 |
|
13 |
13 |
$0.00 |