| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
1,107 |
1,022 |
$125K |
| G0156 |
Hhcp-svs of aide,ea 15 min |
1,294 |
150 |
$97K |
| S5161 |
Emer rspns sys serv permonth |
1,923 |
1,906 |
$53K |
| E0443 |
Portable 02 contents, gas |
573 |
290 |
$23K |
| E0431 |
Portable gaseous 02 |
721 |
695 |
$20K |
| A0427 |
Als1-emergency |
32 |
29 |
$17K |
| E0601 |
Cont airway pressure device |
145 |
144 |
$16K |
| E0562 |
Humidifier heated used w pap |
155 |
153 |
$13K |
| E0570 |
Nebulizer with compression |
281 |
243 |
$12K |
| S5130 |
Homaker service nos per 15m |
66 |
14 |
$4K |
| A0425 |
Ground mileage |
119 |
91 |
$4K |
| G0151 |
Hhcp-serv of pt,ea 15 min |
16 |
13 |
$4K |
| G0152 |
Hhcp-serv of ot,ea 15 min |
32 |
12 |
$3K |
| 80053 |
|
269 |
102 |
$2K |
| 85025 |
|
180 |
92 |
$1K |
| S5160 |
Emer response sys instal&tst |
26 |
26 |
$780.00 |
| 83036 |
|
61 |
29 |
$523.78 |
| 84443 |
|
22 |
12 |
$318.52 |
| 80048 |
|
34 |
14 |
$281.86 |
| 87086 |
|
27 |
13 |
$185.61 |
| 84439 |
|
24 |
12 |
$171.02 |
| 81001 |
|
57 |
27 |
$170.82 |
| 99212 |
|
231 |
137 |
$40.00 |
| 97110 |
|
459 |
231 |
$0.00 |
| T1001 |
Nursing assessment/evaluatn |
118 |
103 |
$0.00 |
| A0130 |
Noner transport wheelch van |
8,060 |
1,762 |
$0.00 |
| 90846 |
|
16 |
12 |
$0.00 |
| 90837 |
|
16 |
12 |
$0.00 |
| 97530 |
|
221 |
114 |
$0.00 |
| 90832 |
|
16 |
12 |
$0.00 |
| 97116 |
|
13 |
12 |
$0.00 |
| T1003 |
Lpn/lvn services up to 15min |
53 |
28 |
$0.00 |
| S9986 |
Not medically necessary svc |
12 |
12 |
$0.00 |
| T1002 |
Rn services up to 15 minutes |
1,089 |
524 |
$0.00 |
| T1016 |
Case management |
1,049 |
666 |
$0.00 |
| S9452 |
Nutrition class |
27 |
27 |
$0.00 |
| S9977 |
Meals per diem |
5,376 |
1,146 |
$0.00 |
| S5101 |
Adult day care per half day |
5,196 |
1,138 |
$0.00 |
| T1004 |
Nsg aide service up to 15min |
6,243 |
979 |
$0.00 |
| 99214 |
|
556 |
454 |
$0.00 |
| 90834 |
|
16 |
12 |
$0.00 |
| S5102 |
Adult day care per diem |
161 |
115 |
$0.00 |
| 96156 |
|
16 |
16 |
$0.00 |
| 36415 |
|
13 |
13 |
$0.00 |
| 90847 |
|
16 |
12 |
$0.00 |
| 99213 |
|
15 |
14 |
$0.00 |
| 97166 |
|
16 |
13 |
$0.00 |
| 97802 |
|
12 |
12 |
$0.00 |
| 99000 |
|
15 |
15 |
$0.00 |