| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2031 |
Assist living waiver/diem |
11,028 |
7,072 |
$17.13M |
| T2033 |
Res, nos waiver per diem |
1,428 |
800 |
$4.34M |
| T2030 |
Assist living waiver/month |
2,039 |
1,648 |
$4.10M |
| E1392 |
Portable oxygen concentrator |
13,566 |
10,956 |
$3.38M |
| A9999 |
Dme supply or accessory, nos |
22,739 |
17,287 |
$2.85M |
| A0427 |
Als1-emergency |
1,936 |
1,633 |
$967K |
| A0429 |
Bls-emergency |
1,738 |
1,420 |
$719K |
| S5161 |
Emer rspns sys serv permonth |
30,826 |
18,576 |
$603K |
| E0601 |
Cont airway pressure device |
4,158 |
3,310 |
$347K |
| 97124 |
|
5,072 |
1,287 |
$326K |
| E1399 |
Durable medical equipment mi |
2,450 |
1,546 |
$297K |
| V2799 |
Misc vision item or service |
1,046 |
878 |
$272K |
| A0425 |
Ground mileage |
4,998 |
3,794 |
$205K |
| A0428 |
Bls |
573 |
459 |
$155K |
| H2018 |
Psysoc rehab svc, per diem |
327 |
222 |
$146K |
| 71046 |
|
581 |
542 |
$144K |
| 97813 |
|
1,322 |
318 |
$138K |
| 98941 |
|
2,062 |
601 |
$122K |
| 98940 |
|
2,176 |
691 |
$115K |
| 82306 |
|
3,661 |
3,409 |
$108K |
| 11056 |
|
1,477 |
1,438 |
$107K |
| E0470 |
Rad w/o backup non-inv intfc |
762 |
614 |
$102K |
| 80307 |
|
1,599 |
1,478 |
$98K |
| 11721 |
|
2,006 |
1,944 |
$89K |
| 97012 |
|
3,722 |
1,019 |
$77K |
| 84443 |
|
4,160 |
3,841 |
$69K |
| G0480 |
Drug test def 1-7 classes |
585 |
537 |
$67K |
| 98960 |
|
979 |
487 |
$64K |
| 97140 |
|
2,623 |
868 |
$63K |
| 92004 |
|
467 |
444 |
$60K |
| K0739 |
Repair/svc dme non-oxygen eq |
81 |
67 |
$58K |
| 85025 |
|
7,194 |
6,478 |
$55K |
| 83036 |
|
5,568 |
5,166 |
$54K |
| 82607 |
|
3,468 |
3,220 |
$52K |
| 80061 |
|
3,634 |
3,377 |
$48K |
| G0483 |
Drug test def 22+ classes |
207 |
188 |
$46K |
| U0003 |
Cov-19 amp prb hgh thruput |
581 |
348 |
$46K |
| 80053 |
|
4,125 |
3,721 |
$43K |
| V5261 |
Hearing aid, digit, bin, bte |
20 |
12 |
$42K |
| 82728 |
|
3,052 |
2,818 |
$41K |
| L2999 |
Lower extremity orthosis nos |
134 |
128 |
$39K |
| 97026 |
|
1,449 |
357 |
$36K |
| 93000 |
|
240 |
227 |
$36K |
| 11057 |
|
482 |
471 |
$35K |
| A4615 |
Cannula nasal |
2,387 |
1,688 |
$35K |
| A5500 |
Diab shoe for density insert |
214 |
203 |
$35K |
| 80048 |
|
4,058 |
3,620 |
$34K |
| A0130 |
Noner transport wheelch van |
17,094 |
3,788 |
$33K |
| 92014 |
|
283 |
265 |
$32K |
| 99213 |
|
1,873 |
1,680 |
$30K |
| 0241U |
|
203 |
170 |
$29K |
| 97810 |
|
1,009 |
320 |
$28K |
| 83550 |
|
3,086 |
2,846 |
$27K |
| 99214 |
|
4,350 |
3,899 |
$25K |
| 83970 |
|
591 |
555 |
$24K |
| 83540 |
|
3,091 |
2,849 |
$20K |
| 97014 |
|
876 |
254 |
$16K |
| D9986 |
|
394 |
269 |
$13K |
| E1353 |
Oxygen supplies regulator |
1,105 |
900 |
$12K |
| P9604 |
One-way allow prorated trip |
1,180 |
901 |
$11K |
| L3060 |
Foot arch supp longitud/meta |
30 |
29 |
$11K |
| A0120 |
Noner transport mini-bus |
22,110 |
2,390 |
$10K |
| A5512 |
Multi den insert direct form |
56 |
55 |
$10K |
| 99348 |
|
158 |
147 |
$10K |
| D9987 |
|
184 |
147 |
$10K |
| 87636 |
|
63 |
60 |
$9K |
| 86803 |
|
626 |
584 |
$9K |
| 87086 |
|
956 |
859 |
$8K |
| G0471 |
Ven blood coll snf/hha |
1,060 |
763 |
$7K |
| 97530 |
|
480 |
202 |
$7K |
| U0005 |
Infec agen detec ampli probe |
392 |
103 |
$7K |
| 87088 |
|
825 |
742 |
$7K |
| 36415 |
|
2,103 |
1,895 |
$6K |
| 99439 |
|
64 |
64 |
$6K |
| A4616 |
Tubing (oxygen) per foot |
637 |
520 |
$5K |
| V2020 |
Vision svcs frames purchases |
68 |
62 |
$5K |
| 82570 |
|
866 |
806 |
$4K |
| 99490 |
Ccm add 20min |
64 |
64 |
$4K |
| G3002 |
Chronic pain mgmt 30 mins |
48 |
34 |
$4K |
| 84439 |
|
360 |
316 |
$3K |
| D0150 |
|
82 |
80 |
$3K |
| 85027 |
|
483 |
411 |
$3K |
| D0330 |
|
59 |
56 |
$3K |
| 83880 |
|
74 |
66 |
$3K |
| 87186 |
|
322 |
290 |
$3K |
| G3003 |
Chronic pain mgmt addl 15m |
48 |
34 |
$3K |
| 99307 |
|
412 |
374 |
$3K |
| P9603 |
One-way allow prorated miles |
557 |
436 |
$3K |
| A5513 |
Multi den insert custom mold |
13 |
13 |
$3K |
| 84156 |
|
690 |
635 |
$3K |
| 87077 |
|
305 |
273 |
$3K |
| 84153 |
|
122 |
102 |
$2K |
| 81003 |
|
913 |
816 |
$2K |
| 84100 |
|
402 |
385 |
$2K |
| U0002 |
Covid-19 lab test non-cdc |
236 |
38 |
$2K |
| D0140 |
|
55 |
54 |
$2K |
| A0999 |
Unlisted ambulance service |
13,217 |
2,943 |
$2K |
| 90832 |
|
1,434 |
917 |
$2K |
| D0220 |
|
139 |
113 |
$2K |
| 82248 |
|
257 |
240 |
$1K |
| A7034 |
Nasal application device |
13 |
12 |
$1K |
| 81001 |
|
323 |
305 |
$1K |
| 83735 |
|
156 |
146 |
$1K |
| 77080 |
|
28 |
28 |
$945.17 |
| D0230 |
|
67 |
20 |
$867.65 |
| 90694 |
|
12 |
12 |
$797.16 |
| 97110 |
|
1,579 |
558 |
$794.00 |
| U0004 |
Cov-19 test non-cdc hgh thru |
78 |
12 |
$735.00 |
| 80299 |
|
30 |
25 |
$559.20 |
| 82652 |
|
14 |
12 |
$539.00 |
| 93005 |
|
1,212 |
1,043 |
$514.58 |
| 92015 |
|
54 |
49 |
$450.40 |
| G2023 |
Specimen collect covid-19 |
147 |
12 |
$436.81 |
| V2750 |
Anti-reflective coating |
13 |
13 |
$411.70 |
| 82746 |
|
27 |
26 |
$396.90 |
| V2784 |
Lens polycarb or equal |
12 |
12 |
$380.00 |
| S0209 |
Wc van mileage per mi |
31 |
13 |
$213.40 |
| G0008 |
Admin influenza virus vac |
153 |
153 |
$210.36 |
| 80069 |
|
23 |
14 |
$199.64 |
| 87635 |
|
23 |
12 |
$51.31 |
| G9012 |
Other specified case mgmt |
10,077 |
6,198 |
$0.00 |
| T1002 |
Rn services up to 15 minutes |
4,015 |
2,610 |
$0.00 |
| S5120 |
Chore services per 15 min |
15,258 |
5,261 |
$0.00 |
| 99309 |
|
423 |
377 |
$0.00 |
| 99417 |
Prolong home eval add 15m |
43 |
43 |
$0.00 |
| A0394 |
Als iv drug therapy supplies |
2,396 |
1,267 |
$0.00 |
| T1016 |
Case management |
3,280 |
2,463 |
$0.00 |
| S5101 |
Adult day care per half day |
51,673 |
14,143 |
$0.00 |
| 97802 |
|
104 |
97 |
$0.00 |
| 99308 |
|
556 |
499 |
$0.00 |
| A4215 |
Sterile needle |
88 |
76 |
$0.00 |
| A0398 |
Als routine disposble suppls |
976 |
640 |
$0.00 |
| 96151 |
|
310 |
276 |
$0.00 |
| S5125 |
Attendant care service /15m |
2,926 |
757 |
$0.00 |
| 99305 |
|
83 |
74 |
$0.00 |
| 99000 |
|
396 |
351 |
$0.00 |
| 99443 |
|
85 |
81 |
$0.00 |
| 98967 |
|
14 |
12 |
$0.00 |
| 90834 |
|
65 |
45 |
$0.00 |
| T1019 |
Personal care ser per 15 min |
189 |
109 |
$0.00 |
| A6260 |
Wound cleanser any type/size |
210 |
73 |
$0.00 |
| S9445 |
Pt education noc individ |
61 |
41 |
$0.00 |
| A4253 |
Blood glucose/reagent strips |
192 |
171 |
$0.00 |
| 96372 |
|
93 |
27 |
$0.00 |
| S9097 |
Home visit wound care |
193 |
71 |
$0.00 |
| 97112 |
|
104 |
58 |
$0.00 |
| 96156 |
|
64 |
64 |
$0.00 |
| 97162 |
|
70 |
68 |
$0.00 |
| G0108 |
Diab manage trn per indiv |
15 |
12 |
$0.00 |
| 96150 |
|
14 |
13 |
$0.00 |
| E0130 |
Walker rigid adjust/fixed ht |
23 |
15 |
$0.00 |
| 99441 |
|
23 |
20 |
$0.00 |
| A9901 |
Delivery/set up/dispensing |
7,276 |
4,363 |
$0.00 |
| S5130 |
Homaker service nos per 15m |
42,190 |
10,009 |
$0.00 |
| T1003 |
Lpn/lvn services up to 15min |
868 |
602 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
405 |
373 |
$0.00 |
| A0422 |
Ambulance 02 life sustaining |
462 |
409 |
$0.00 |
| 11719 |
|
688 |
671 |
$0.00 |
| A6250 |
Skin seal protect moisturizr |
48 |
16 |
$0.00 |
| 96160 |
|
497 |
471 |
$0.00 |
| S5170 |
Homedelivered prepared meal |
3,181 |
1,939 |
$0.00 |
| B4154 |
Ef spec metabolic noninherit |
1,832 |
1,435 |
$0.00 |
| S9986 |
Not medically necessary svc |
174 |
157 |
$0.00 |
| 3288F |
|
70 |
52 |
$0.00 |
| S9470 |
Nutritional counseling, diet |
356 |
299 |
$0.00 |
| 96152 |
|
343 |
302 |
$0.00 |
| 99497 |
|
41 |
41 |
$0.00 |
| A0382 |
Basic support routine suppls |
305 |
230 |
$0.00 |
| 98966 |
|
213 |
168 |
$0.00 |
| S9123 |
Nursing care in home rn |
296 |
266 |
$0.00 |
| 90653 |
|
142 |
142 |
$0.00 |
| G2012 |
Brief check in by md/qhp |
164 |
114 |
$0.00 |
| 99211 |
|
442 |
200 |
$0.00 |
| 99442 |
|
30 |
28 |
$0.00 |
| A4369 |
Skin barrier liquid per oz |
28 |
13 |
$0.00 |
| 99212 |
|
24 |
24 |
$0.00 |
| 93041 |
|
31 |
24 |
$0.00 |
| V5266 |
Battery for hearing device |
60 |
56 |
$0.00 |
| 90837 |
|
17 |
12 |
$0.00 |
| 87811 |
|
13 |
13 |
$0.00 |
| 96158 |
|
31 |
31 |
$0.00 |
| A6209 |
Foam drsg <=16 sq in w/o bdr |
29 |
13 |
$0.00 |