| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 00731 |
|
1,812 |
1,672 |
$120K |
| 00170 |
|
979 |
939 |
$93K |
| 90999 |
|
2,753 |
67 |
$29K |
| 00813 |
|
288 |
282 |
$25K |
| G0463 |
Hospital outpt clinic visit |
2,026 |
828 |
$24K |
| 99213 |
|
1,350 |
1,078 |
$23K |
| 99214 |
|
1,035 |
769 |
$21K |
| 93005 |
|
1,150 |
104 |
$19K |
| 36620 |
|
347 |
270 |
$16K |
| 99284 |
|
381 |
56 |
$14K |
| 99232 |
|
886 |
347 |
$13K |
| 00811 |
|
185 |
172 |
$10K |
| 99233 |
Prolong inpt eval add15 m |
445 |
186 |
$9K |
| 99223 |
Prolong inpt eval add15 m |
163 |
144 |
$7K |
| 01961 |
|
47 |
42 |
$6K |
| 99285 |
|
245 |
28 |
$6K |
| 90837 |
|
220 |
161 |
$6K |
| 01480 |
|
81 |
77 |
$5K |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
171 |
22 |
$5K |
| 00790 |
|
39 |
37 |
$5K |
| J3301 |
Triamcinolone acet inj nos |
66 |
25 |
$5K |
| 96372 |
|
46 |
12 |
$4K |
| 99283 |
|
242 |
63 |
$4K |
| G0008 |
Admin influenza virus vac |
502 |
56 |
$4K |
| A9270 |
Non-covered item or service |
266 |
30 |
$4K |
| 93010 |
|
278 |
101 |
$4K |
| 74177 |
|
101 |
87 |
$4K |
| 99222 |
|
107 |
94 |
$3K |
| 00840 |
|
27 |
24 |
$3K |
| E1390 |
Oxygen concentrator |
113 |
113 |
$3K |
| 74176 |
|
33 |
25 |
$3K |
| 99308 |
|
139 |
127 |
$2K |
| 99239 |
|
99 |
96 |
$2K |
| 97110 |
|
230 |
91 |
$2K |
| 99212 |
|
139 |
126 |
$2K |
| 90961 |
|
39 |
39 |
$2K |
| 99215 |
Prolong outpt/office vis |
69 |
67 |
$2K |
| 31500 |
|
17 |
16 |
$2K |
| 70450 |
|
140 |
127 |
$2K |
| 90834 |
|
119 |
106 |
$2K |
| 99309 |
|
61 |
61 |
$2K |
| 36410 |
|
125 |
98 |
$1K |
| A0427 |
Als1-emergency |
15 |
13 |
$1K |
| 71046 |
|
225 |
172 |
$1K |
| 71045 |
|
481 |
347 |
$1K |
| 90832 |
|
116 |
99 |
$1K |
| 99238 |
|
83 |
83 |
$1K |
| 20610 |
|
41 |
22 |
$1K |
| 99204 |
|
34 |
34 |
$1K |
| 97112 |
|
84 |
32 |
$1K |
| 97140 |
|
45 |
22 |
$974.34 |
| 99291 |
|
41 |
15 |
$966.72 |
| 93306 |
|
29 |
21 |
$960.97 |
| 99231 |
|
131 |
68 |
$944.88 |
| 99282 |
|
46 |
21 |
$937.09 |
| A0425 |
Ground mileage |
31 |
29 |
$818.99 |
| 90960 |
|
14 |
14 |
$795.62 |
| 98941 |
|
71 |
54 |
$754.64 |
| 01810 |
|
12 |
12 |
$744.57 |
| 01830 |
|
12 |
12 |
$733.16 |
| 00812 |
|
12 |
12 |
$598.50 |
| 00400 |
|
14 |
13 |
$594.91 |
| 99221 |
|
33 |
30 |
$591.34 |
| 97161 |
|
45 |
15 |
$586.10 |
| 93971 |
|
25 |
14 |
$578.34 |
| 99442 |
|
54 |
52 |
$543.25 |
| 97530 |
|
33 |
12 |
$541.92 |
| 71275 |
|
27 |
26 |
$539.85 |
| 73030 |
|
29 |
20 |
$521.62 |
| 90935 |
|
35 |
26 |
$506.48 |
| 99203 |
|
21 |
18 |
$493.56 |
| G2025 |
Dis site tele svcs rhc/fqhc |
47 |
44 |
$488.48 |
| 99205 |
Prolong outpt/office vis |
14 |
14 |
$460.34 |
| 99211 |
|
21 |
13 |
$397.14 |
| 88305 |
|
31 |
30 |
$376.06 |
| Q3014 |
Telehealth facility fee |
71 |
67 |
$341.12 |
| 92014 |
|
15 |
13 |
$328.31 |
| 93296 |
|
37 |
37 |
$309.52 |
| 11721 |
|
38 |
34 |
$287.37 |
| 93970 |
|
17 |
12 |
$273.51 |
| 99443 |
|
14 |
12 |
$254.97 |
| 99202 |
|
16 |
16 |
$235.75 |
| 71260 |
|
14 |
14 |
$209.56 |
| 90833 |
|
15 |
13 |
$177.55 |
| E0601 |
Cont airway pressure device |
14 |
14 |
$169.52 |
| A4604 |
Tubing with heating element |
12 |
12 |
$137.61 |
| 73502 |
|
17 |
14 |
$124.15 |
| E1392 |
Portable oxygen concentrator |
16 |
16 |
$119.49 |
| A7038 |
Pos airway pressure filter |
30 |
30 |
$111.46 |
| 94729 |
|
16 |
14 |
$81.22 |
| 73630 |
|
32 |
28 |
$77.31 |
| A7035 |
Pos airway press headgear |
13 |
12 |
$67.00 |
| 74018 |
|
31 |
26 |
$56.73 |
| 99441 |
|
17 |
16 |
$51.36 |
| E0431 |
Portable gaseous 02 |
13 |
13 |
$49.54 |
| 99152 |
|
17 |
13 |
$34.16 |
| A4253 |
Blood glucose/reagent strips |
17 |
17 |
$31.62 |
| 11720 |
|
13 |
12 |
$31.53 |
| 85048 |
|
15 |
15 |
$0.00 |
| 85041 |
|
15 |
15 |
$0.00 |
| 83970 |
|
13 |
13 |
$0.00 |
| A4657 |
Syringe w/wo needle |
16 |
16 |
$0.00 |
| Q4081 |
Epoetin alfa, 100 units esrd |
16 |
16 |
$0.00 |
| 36415 |
|
12 |
12 |
$0.00 |
| J1270 |
Injection, doxercalciferol |
12 |
12 |
$0.00 |