| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| G0108 |
Diabetes outpatient self-management training services, individual, per 30 minutes |
327 |
254 |
$2K |
| A4239 |
Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service |
330 |
292 |
$426.59 |
| G0109 |
Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes |
1,150 |
280 |
$201.95 |
| 0004A |
|
150 |
147 |
$120.00 |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
182 |
86 |
$66.60 |
| 0064A |
|
65 |
65 |
$40.00 |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
116 |
54 |
$37.30 |
| M0201 |
Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home |
125 |
122 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
168 |
157 |
$0.00 |
| K1034 |
Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count |
39 |
38 |
$0.00 |
| 90694 |
|
89 |
79 |
$0.00 |
| 0134A |
|
48 |
43 |
$0.00 |
| 90480 |
|
176 |
174 |
$0.00 |
| 0124A |
|
180 |
160 |
$0.00 |
| 0054A |
|
89 |
89 |
$0.00 |
| 91320 |
|
176 |
174 |
$0.00 |
| 90653 |
|
60 |
60 |
$0.00 |