| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2030 |
Assist living waiver/month |
1,243 |
1,054 |
$1.68M |
| A9999 |
Dme supply or accessory, nos |
2,852 |
2,252 |
$318K |
| E1390 |
Oxygen concentrator |
2,143 |
1,800 |
$111K |
| E1392 |
Portable oxygen concentrator |
1,353 |
1,031 |
$93K |
| A0429 |
Bls-emergency |
373 |
261 |
$72K |
| A0427 |
Als1-emergency |
317 |
247 |
$72K |
| S5161 |
Emer rspns sys serv permonth |
4,862 |
3,840 |
$69K |
| E0601 |
Cont airway pressure device |
635 |
522 |
$33K |
| U0004 |
Cov-19 test non-cdc hgh thru |
212 |
40 |
$17K |
| A0425 |
Ground mileage |
879 |
589 |
$15K |
| E0431 |
Portable gaseous 02 |
734 |
625 |
$8K |
| 80053 |
|
998 |
915 |
$7K |
| 97140 |
|
62 |
12 |
$6K |
| 82306 |
|
301 |
288 |
$6K |
| 84443 |
|
444 |
407 |
$5K |
| 83036 |
|
829 |
771 |
$5K |
| 80061 |
|
465 |
450 |
$5K |
| 85025 |
|
1,038 |
923 |
$5K |
| U0005 |
Infec agen detec ampli probe |
166 |
39 |
$4K |
| 82607 |
|
219 |
216 |
$2K |
| 11721 |
|
39 |
39 |
$2K |
| E0562 |
Humidifier heated used w pap |
83 |
73 |
$1K |
| 80307 |
|
14 |
12 |
$978.60 |
| E0570 |
Nebulizer with compression |
86 |
73 |
$952.84 |
| 84439 |
|
80 |
79 |
$788.42 |
| 82652 |
|
14 |
14 |
$660.10 |
| 82570 |
|
93 |
90 |
$513.54 |
| 83735 |
|
87 |
83 |
$336.20 |
| 82746 |
|
25 |
25 |
$234.13 |
| 82043 |
|
29 |
29 |
$205.32 |
| 81001 |
|
37 |
26 |
$50.44 |
| A7035 |
Pos airway press headgear |
14 |
14 |
$0.00 |
| A7038 |
Pos airway pressure filter |
20 |
20 |
$0.00 |
| 87186 |
|
29 |
27 |
$0.00 |
| 90687 |
|
13 |
13 |
$0.00 |
| 87088 |
|
57 |
54 |
$0.00 |
| 99213 |
|
23 |
12 |
$0.00 |
| 80048 |
|
16 |
16 |
$0.00 |
| 87086 |
|
132 |
105 |
$0.00 |
| G0008 |
Admin influenza virus vac |
16 |
16 |
$0.00 |