| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2030 |
Assist living waiver/month |
7,257 |
5,507 |
$17.13M |
| T2031 |
Assist living waiver/diem |
453 |
355 |
$1.31M |
| A9999 |
Dme supply or accessory, nos |
6,136 |
4,906 |
$869K |
| E1392 |
Portable oxygen concentrator |
2,537 |
2,154 |
$490K |
| E1390 |
Oxygen concentrator |
3,291 |
2,946 |
$336K |
| A0427 |
Als1-emergency |
611 |
542 |
$295K |
| S5161 |
Emer rspns sys serv permonth |
6,661 |
4,923 |
$176K |
| 11719 |
|
5,118 |
2,484 |
$170K |
| E0601 |
Cont airway pressure device |
2,003 |
1,705 |
$169K |
| U0003 |
Cov-19 amp prb hgh thruput |
2,153 |
540 |
$166K |
| A0429 |
Bls-emergency |
262 |
238 |
$108K |
| E0277 |
Powered pres-redu air mattrs |
844 |
627 |
$93K |
| 99213 |
|
1,907 |
960 |
$85K |
| A0428 |
Bls |
297 |
172 |
$74K |
| T2033 |
Res, nos waiver per diem |
50 |
34 |
$72K |
| A0425 |
Ground mileage |
1,918 |
1,422 |
$68K |
| R0070 |
Transport portable x-ray |
261 |
243 |
$58K |
| 90837 |
|
527 |
226 |
$57K |
| U0005 |
Infec agen detec ampli probe |
1,963 |
475 |
$51K |
| E0434 |
Portable liquid 02 |
1,095 |
854 |
$44K |
| 82306 |
|
1,174 |
1,163 |
$42K |
| D9410 |
|
398 |
246 |
$42K |
| 84443 |
|
1,517 |
1,483 |
$32K |
| 80053 |
|
2,205 |
2,102 |
$28K |
| E0439 |
Stationary liquid 02 |
226 |
224 |
$26K |
| 83036 |
|
1,930 |
1,893 |
$23K |
| 98960 |
|
146 |
140 |
$21K |
| 85025 |
|
2,439 |
2,302 |
$20K |
| 80061 |
|
1,240 |
1,221 |
$20K |
| 99309 |
|
224 |
116 |
$20K |
| E0443 |
Portable 02 contents, gas |
322 |
266 |
$19K |
| E0431 |
Portable gaseous 02 |
909 |
807 |
$17K |
| 99308 |
|
215 |
164 |
$15K |
| 11721 |
|
308 |
300 |
$15K |
| E0466 |
Home vent non-invasive inter |
14 |
14 |
$14K |
| A4615 |
Cannula nasal |
2,617 |
1,412 |
$14K |
| T1017 |
Targeted case management |
460 |
156 |
$12K |
| E0562 |
Humidifier heated used w pap |
596 |
545 |
$11K |
| E0444 |
Portable 02 contents, liquid |
223 |
213 |
$11K |
| A0433 |
Als 2 |
16 |
15 |
$11K |
| E0265 |
Hosp bed total electr w/ mat |
262 |
149 |
$10K |
| E0442 |
Stationary o2 contents, liq |
420 |
419 |
$10K |
| 71046 |
|
84 |
83 |
$9K |
| 82607 |
|
471 |
460 |
$9K |
| Q0092 |
Set up port xray equipment |
291 |
265 |
$8K |
| E0570 |
Nebulizer with compression |
715 |
629 |
$8K |
| E0184 |
Dry pressure mattress |
231 |
172 |
$8K |
| 80048 |
|
734 |
699 |
$7K |
| 99214 |
|
492 |
466 |
$7K |
| 92015 |
|
150 |
149 |
$7K |
| G2024 |
Spec coll snf/lab covid-19 |
256 |
117 |
$7K |
| 92014 |
|
49 |
33 |
$6K |
| E0470 |
Rad w/o backup non-inv intfc |
41 |
41 |
$6K |
| S5162 |
Emer rspns system purchase |
36 |
36 |
$6K |
| 83970 |
|
132 |
129 |
$6K |
| D0140 |
|
140 |
54 |
$5K |
| 93922 |
|
18 |
18 |
$5K |
| 93306 |
|
13 |
13 |
$5K |
| P9604 |
One-way allow prorated trip |
251 |
208 |
$5K |
| 82652 |
|
95 |
94 |
$4K |
| V5299 |
Hearing service |
161 |
141 |
$4K |
| 98941 |
|
87 |
45 |
$4K |
| E0471 |
Rad w/backup non inv intrfc |
12 |
12 |
$4K |
| 77067 |
|
31 |
31 |
$4K |
| D0350 |
|
102 |
42 |
$4K |
| 93971 |
|
12 |
12 |
$4K |
| V2020 |
Vision svcs frames purchases |
51 |
51 |
$3K |
| D5410 |
|
60 |
27 |
$3K |
| 84439 |
|
242 |
238 |
$2K |
| 80307 |
|
33 |
32 |
$2K |
| 82728 |
|
152 |
142 |
$2K |
| G0471 |
Ven blood coll snf/hha |
430 |
340 |
$2K |
| A4616 |
Tubing (oxygen) per foot |
844 |
513 |
$2K |
| 68761 |
|
12 |
12 |
$2K |
| E1353 |
Oxygen supplies regulator |
333 |
282 |
$2K |
| 82746 |
|
104 |
102 |
$2K |
| 73562 |
|
15 |
13 |
$2K |
| 77063 |
|
31 |
31 |
$2K |
| H0032 |
Mh svc plan dev by non-md |
33 |
33 |
$2K |
| V2744 |
Tint photochromatic lens/es |
16 |
16 |
$2K |
| 87086 |
|
159 |
152 |
$2K |
| 83550 |
|
161 |
153 |
$2K |
| 99203 |
|
13 |
12 |
$1K |
| 83540 |
|
203 |
194 |
$1K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
16 |
16 |
$1K |
| 99490 |
Ccm add 20min |
37 |
37 |
$1K |
| A7030 |
Cpap full face mask |
12 |
12 |
$1K |
| 82570 |
|
218 |
214 |
$1K |
| D5411 |
|
24 |
12 |
$1K |
| 82310 |
|
218 |
176 |
$1K |
| D0150 |
|
29 |
29 |
$1K |
| A7038 |
Pos airway pressure filter |
168 |
163 |
$1K |
| A7031 |
Replacement facemask interfa |
22 |
22 |
$954.58 |
| G2211 |
Complex e/m visit add on |
59 |
45 |
$952.29 |
| E1354 |
Wheeled cart, port cyl/conc |
185 |
171 |
$950.25 |
| 84100 |
|
190 |
151 |
$942.53 |
| 99304 |
|
12 |
12 |
$900.13 |
| 87635 |
|
17 |
16 |
$854.76 |
| 87186 |
|
69 |
65 |
$804.84 |
| 82043 |
|
113 |
111 |
$800.04 |
| 92593 |
|
19 |
18 |
$760.00 |
| V2784 |
Lens polycarb or equal |
12 |
12 |
$720.00 |
| 87088 |
|
70 |
67 |
$704.32 |
| 81001 |
|
166 |
161 |
$601.39 |
| 83880 |
|
15 |
14 |
$599.10 |
| 92557 |
|
25 |
14 |
$592.56 |
| 77080 |
|
14 |
14 |
$539.70 |
| 83735 |
|
65 |
65 |
$533.00 |
| P9603 |
One-way allow prorated miles |
148 |
112 |
$524.26 |
| D0180 |
|
15 |
15 |
$492.15 |
| 93010 |
|
45 |
39 |
$411.46 |
| A7037 |
Pos airway pressure tubing |
15 |
15 |
$380.85 |
| 80069 |
|
30 |
29 |
$319.20 |
| D0460 |
|
12 |
12 |
$315.72 |
| 84153 |
|
14 |
13 |
$315.42 |
| 92700 |
|
25 |
14 |
$300.00 |
| A7035 |
Pos airway press headgear |
13 |
13 |
$281.45 |
| K0001 |
Standard wheelchair |
21 |
21 |
$210.00 |
| D1208 |
|
17 |
17 |
$151.81 |
| 87077 |
|
16 |
14 |
$147.56 |
| 85027 |
|
16 |
15 |
$97.60 |
| 84156 |
|
21 |
19 |
$94.29 |
| 84520 |
|
16 |
16 |
$62.56 |
| 82565 |
|
16 |
16 |
$58.78 |
| 84155 |
|
16 |
16 |
$55.48 |
| 84075 |
|
15 |
15 |
$54.69 |
| 84295 |
|
15 |
15 |
$52.51 |
| 82040 |
|
14 |
14 |
$50.64 |
| 36415 |
|
15 |
12 |
$49.50 |
| 82374 |
|
15 |
15 |
$48.97 |
| 82435 |
|
15 |
15 |
$48.83 |
| 84450 |
|
13 |
13 |
$42.01 |
| 84460 |
|
13 |
13 |
$42.01 |
| 82247 |
|
13 |
13 |
$42.01 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
23 |
17 |
$16.61 |
| 99215 |
Prolong outpt/office vis |
67 |
64 |
$0.00 |
| 97163 |
|
1,499 |
645 |
$0.00 |
| 90832 |
|
932 |
499 |
$0.00 |
| 97167 |
|
1,283 |
611 |
$0.00 |
| T1001 |
Nursing assessment/evaluatn |
957 |
754 |
$0.00 |
| S9470 |
Nutritional counseling, diet |
562 |
507 |
$0.00 |
| H0046 |
Mental health service, nos |
1,059 |
533 |
$0.00 |
| G0422 |
Intens cardiac rehab w/exerc |
74 |
60 |
$0.00 |
| A0130 |
Noner transport wheelch van |
6,980 |
1,947 |
$0.00 |
| 99442 |
|
325 |
256 |
$0.00 |
| 97161 |
|
468 |
362 |
$0.00 |
| H2032 |
Activity therapy, per 15 min |
361 |
335 |
$0.00 |
| S0221 |
Medical conference, 60 min |
68 |
64 |
$0.00 |
| G0079 |
Care manag h vst new pt 60 m |
253 |
250 |
$0.00 |
| 97165 |
|
286 |
247 |
$0.00 |
| S5101 |
Adult day care per half day |
2,584 |
330 |
$0.00 |
| G0409 |
Corf related serv 15 mins ea |
2,123 |
1,118 |
$0.00 |
| S5102 |
Adult day care per diem |
113 |
12 |
$0.00 |
| Q5001 |
Hospice or home hlth in home |
1,199 |
401 |
$0.00 |
| 99305 |
|
170 |
137 |
$0.00 |
| H0033 |
Oral med adm direct observe |
114 |
47 |
$0.00 |
| 92507 |
|
210 |
144 |
$0.00 |
| 98967 |
|
2,012 |
1,169 |
$0.00 |
| S0220 |
Medical conference by physic |
797 |
305 |
$0.00 |
| 97166 |
|
131 |
126 |
$0.00 |
| 97162 |
|
190 |
158 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
13 |
13 |
$0.00 |