| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2030 |
Assist living waiver/month |
6,006 |
5,173 |
$8.20M |
| T2031 |
Assist living waiver/diem |
1,151 |
968 |
$1.49M |
| A9999 |
Dme supply or accessory, nos |
8,469 |
6,466 |
$719K |
| E1392 |
Portable oxygen concentrator |
5,481 |
4,417 |
$625K |
| E1390 |
Oxygen concentrator |
2,807 |
2,527 |
$189K |
| 90837 |
|
1,129 |
366 |
$158K |
| E0601 |
Cont airway pressure device |
2,645 |
2,188 |
$140K |
| 11719 |
|
5,323 |
2,542 |
$118K |
| S5161 |
Emer rspns sys serv permonth |
8,102 |
6,025 |
$97K |
| 99309 |
|
825 |
351 |
$76K |
| A0427 |
Als1-emergency |
234 |
205 |
$68K |
| E0434 |
Portable liquid 02 |
2,044 |
1,608 |
$53K |
| U0003 |
Cov-19 amp prb hgh thruput |
638 |
241 |
$49K |
| 99308 |
|
830 |
632 |
$46K |
| 99213 |
|
1,849 |
709 |
$44K |
| E0466 |
Home vent non-invasive inter |
36 |
36 |
$37K |
| T1017 |
Targeted case management |
1,088 |
346 |
$32K |
| 84443 |
|
2,131 |
2,108 |
$26K |
| 82306 |
|
786 |
781 |
$20K |
| 80053 |
|
2,550 |
2,479 |
$20K |
| V5257 |
Hearing aid, digit, mon, bte |
12 |
12 |
$19K |
| A0425 |
Ground mileage |
782 |
665 |
$17K |
| E0439 |
Stationary liquid 02 |
138 |
138 |
$16K |
| 83036 |
|
2,169 |
2,152 |
$16K |
| 85025 |
|
3,011 |
2,857 |
$16K |
| 80061 |
|
1,497 |
1,492 |
$15K |
| E0442 |
Stationary o2 contents, liq |
824 |
816 |
$12K |
| A0428 |
Bls |
57 |
52 |
$10K |
| 82607 |
|
1,011 |
1,003 |
$10K |
| 82652 |
|
484 |
483 |
$10K |
| P9604 |
One-way allow prorated trip |
148 |
120 |
$9K |
| U0005 |
Infec agen detec ampli probe |
354 |
130 |
$9K |
| E0431 |
Portable gaseous 02 |
477 |
393 |
$8K |
| E0444 |
Portable 02 contents, liquid |
162 |
152 |
$8K |
| E0265 |
Hosp bed total electr w/ mat |
451 |
324 |
$8K |
| T2033 |
Res, nos waiver per diem |
34 |
27 |
$7K |
| E0562 |
Humidifier heated used w pap |
369 |
369 |
$7K |
| V5160 |
Dispensing fee binaural |
13 |
13 |
$6K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
70 |
69 |
$6K |
| V2744 |
Tint photochromatic lens/es |
63 |
63 |
$6K |
| V2020 |
Vision svcs frames purchases |
91 |
87 |
$6K |
| V2781 |
Progressive lens per lens |
37 |
36 |
$6K |
| 80048 |
|
765 |
720 |
$5K |
| E0443 |
Portable 02 contents, gas |
99 |
94 |
$5K |
| 86480 |
|
108 |
108 |
$5K |
| 84439 |
|
514 |
507 |
$5K |
| E0570 |
Nebulizer with compression |
353 |
327 |
$4K |
| 99212 |
|
184 |
107 |
$4K |
| 87086 |
|
571 |
540 |
$4K |
| 90834 |
|
34 |
13 |
$4K |
| E0184 |
Dry pressure mattress |
227 |
192 |
$3K |
| 99310 |
Prolong nursin fac eval 15m |
25 |
22 |
$3K |
| 99318 |
|
33 |
33 |
$3K |
| H0032 |
Mh svc plan dev by non-md |
61 |
59 |
$3K |
| 90791 |
|
22 |
18 |
$3K |
| 11042 |
|
17 |
12 |
$2K |
| 98941 |
|
255 |
116 |
$2K |
| 92015 |
|
30 |
30 |
$2K |
| 87186 |
|
217 |
211 |
$2K |
| G0471 |
Ven blood coll snf/hha |
297 |
242 |
$2K |
| 99304 |
|
21 |
21 |
$2K |
| 87088 |
|
244 |
237 |
$2K |
| 92014 |
|
12 |
12 |
$2K |
| V5299 |
Hearing service |
61 |
61 |
$2K |
| 92591 |
|
13 |
13 |
$1K |
| 81001 |
|
512 |
491 |
$1K |
| 11720 |
|
19 |
19 |
$1K |
| K0001 |
Standard wheelchair |
103 |
97 |
$1K |
| 82570 |
|
185 |
184 |
$893.94 |
| A4615 |
Cannula nasal |
90 |
87 |
$747.00 |
| A7038 |
Pos airway pressure filter |
93 |
93 |
$628.32 |
| V5011 |
Hearing aid fitting/checking |
13 |
13 |
$585.00 |
| 82746 |
|
80 |
79 |
$558.31 |
| P9603 |
One-way allow prorated miles |
126 |
89 |
$520.42 |
| 92700 |
|
21 |
15 |
$495.00 |
| 82043 |
|
68 |
68 |
$481.44 |
| H0002 |
Alcohol and/or drug screenin |
23 |
19 |
$437.00 |
| A7037 |
Pos airway pressure tubing |
12 |
12 |
$304.68 |
| 83550 |
|
63 |
61 |
$278.46 |
| 87077 |
|
43 |
43 |
$269.08 |
| 83540 |
|
87 |
85 |
$206.18 |
| 86803 |
|
46 |
46 |
$157.32 |
| E1353 |
Oxygen supplies regulator |
25 |
24 |
$142.56 |
| 36415 |
|
19 |
12 |
$62.51 |
| A0999 |
Unlisted ambulance service |
26 |
24 |
$0.00 |
| S5102 |
Adult day care per diem |
66 |
13 |
$0.00 |
| 83880 |
|
12 |
12 |
$0.00 |
| G0409 |
Corf related serv 15 mins ea |
33 |
13 |
$0.00 |
| A4616 |
Tubing (oxygen) per foot |
26 |
15 |
$0.00 |
| 98960 |
|
147 |
92 |
$0.00 |
| 84156 |
|
13 |
12 |
$0.00 |