| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1390 |
Oxygen concentrator |
4,455 |
4,030 |
$713K |
| S5161 |
Emer rspns sys serv permonth |
5,984 |
5,488 |
$164K |
| 97124 |
|
772 |
346 |
$77K |
| E0431 |
Portable gaseous 02 |
1,504 |
1,352 |
$44K |
| S0390 |
Rout foot care per visit |
592 |
516 |
$30K |
| K0738 |
Portable gas oxygen system |
494 |
455 |
$25K |
| U0004 |
Cov-19 test non-cdc hgh thru |
203 |
60 |
$15K |
| 85025 |
|
876 |
571 |
$7K |
| 80053 |
|
637 |
370 |
$7K |
| 87635 |
|
159 |
139 |
$5K |
| S5130 |
Homaker service nos per 15m |
5,563 |
1,274 |
$4K |
| 87637 |
|
26 |
13 |
$4K |
| U0003 |
Cov-19 amp prb hgh thruput |
49 |
21 |
$4K |
| U0005 |
Infec agen detec ampli probe |
140 |
56 |
$4K |
| 82306 |
|
84 |
53 |
$2K |
| 84443 |
|
118 |
87 |
$2K |
| 80048 |
|
170 |
145 |
$1K |
| 80061 |
|
79 |
52 |
$1K |
| 82607 |
|
28 |
24 |
$422.24 |
| 83036 |
|
47 |
44 |
$330.14 |
| 99000 |
|
270 |
250 |
$0.00 |
| G0008 |
Admin influenza virus vac |
84 |
84 |
$0.00 |
| G0506 |
Comp asses care plan ccm svc |
813 |
792 |
$0.00 |
| S9445 |
Pt education noc individ |
541 |
458 |
$0.00 |
| S9977 |
Meals per diem |
3,072 |
2,708 |
$0.00 |
| A0120 |
Noner transport mini-bus |
1,775 |
327 |
$0.00 |
| G9473 |
Chap services at hospice |
874 |
572 |
$0.00 |
| 96372 |
|
708 |
390 |
$0.00 |
| 36415 |
|
1,542 |
1,325 |
$0.00 |
| S5102 |
Adult day care per diem |
3,054 |
2,813 |
$0.00 |
| 96151 |
|
569 |
544 |
$0.00 |
| 97165 |
|
70 |
69 |
$0.00 |
| T1019 |
Personal care ser per 15 min |
47,473 |
2,325 |
$0.00 |
| 98967 |
|
778 |
617 |
$0.00 |
| G0300 |
Hhs/hospice of lpn ea 15 min |
2,265 |
1,488 |
$0.00 |
| G0299 |
Hhs/hospice of rn ea 15 min |
1,776 |
1,364 |
$0.00 |
| 99214 |
|
815 |
696 |
$0.00 |
| S5185 |
Med reminder serv per month |
3,365 |
3,183 |
$0.00 |
| 97010 |
|
89 |
50 |
$0.00 |
| T1016 |
Case management |
6,034 |
3,296 |
$0.00 |
| S9097 |
Home visit wound care |
1,166 |
355 |
$0.00 |
| 97535 |
|
707 |
501 |
$0.00 |
| 97112 |
|
1,021 |
538 |
$0.00 |
| D0150 |
|
29 |
29 |
$0.00 |
| T1002 |
Rn services up to 15 minutes |
3,508 |
2,141 |
$0.00 |
| 99213 |
|
704 |
615 |
$0.00 |
| T1502 |
Medication admin visit |
13 |
12 |
$0.00 |
| S5101 |
Adult day care per half day |
415 |
400 |
$0.00 |
| T1004 |
Nsg aide service up to 15min |
4,589 |
207 |
$0.00 |
| G0494 |
Lpn care ea 15min hh/hospice |
127 |
104 |
$0.00 |
| G0151 |
Hhcp-serv of pt,ea 15 min |
224 |
149 |
$0.00 |
| G0493 |
Rn care ea 15 min hh/hospice |
405 |
325 |
$0.00 |
| 99441 |
|
16 |
13 |
$0.00 |
| 90834 |
|
58 |
52 |
$0.00 |
| S0257 |
End of life counseling |
50 |
50 |
$0.00 |
| 96112 |
|
15 |
13 |
$0.00 |
| 97140 |
|
268 |
156 |
$0.00 |
| 95250 |
|
58 |
44 |
$0.00 |
| 90471 |
|
50 |
47 |
$0.00 |
| D0210 |
|
29 |
29 |
$0.00 |
| 97110 |
|
4,421 |
1,677 |
$0.00 |
| T1003 |
Lpn/lvn services up to 15min |
2,730 |
1,828 |
$0.00 |
| 99367 |
|
1,099 |
906 |
$0.00 |
| 90853 |
|
218 |
136 |
$0.00 |
| A0130 |
Noner transport wheelch van |
47,680 |
4,633 |
$0.00 |
| 97803 |
|
494 |
454 |
$0.00 |
| 97530 |
|
1,405 |
783 |
$0.00 |
| 99211 |
|
4,810 |
3,122 |
$0.00 |
| S5170 |
Homedelivered prepared meal |
674 |
657 |
$0.00 |
| T1001 |
Nursing assessment/evaluatn |
2,079 |
1,527 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
226 |
224 |
$0.00 |
| 97164 |
|
399 |
387 |
$0.00 |
| 98966 |
|
6,551 |
3,234 |
$0.00 |
| 11719 |
|
116 |
114 |
$0.00 |
| G0162 |
Hhc rn e&m plan svs, 15 min |
1,036 |
942 |
$0.00 |
| 97799 |
|
437 |
155 |
$0.00 |
| S9986 |
Not medically necessary svc |
385 |
373 |
$0.00 |
| G0175 |
Opps service,sched team conf |
14,395 |
5,474 |
$0.00 |
| 97116 |
|
1,314 |
562 |
$0.00 |
| 97150 |
|
106 |
56 |
$0.00 |
| 98968 |
|
89 |
76 |
$0.00 |
| S9127 |
Social work visit, in the ho |
145 |
126 |
$0.00 |
| G0495 |
Rn care train/edu in hh |
13 |
12 |
$0.00 |
| G0163 |
Hhc lpn/rn obs/asses ea 15 |
64 |
59 |
$0.00 |
| A9901 |
Delivery/set up/dispensing |
12 |
12 |
$0.00 |
| 90658 |
|
122 |
122 |
$0.00 |
| 90832 |
|
52 |
44 |
$0.00 |
| 97161 |
|
13 |
12 |
$0.00 |
| S9470 |
Nutritional counseling, diet |
19 |
13 |
$0.00 |
| D0350 |
|
15 |
15 |
$0.00 |
| 90837 |
|
13 |
12 |
$0.00 |