| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A0100 |
Nonemergency transport taxi |
3,654,081 |
360,975 |
$70.64M |
| S0215 |
Nonemerg transp mileage |
2,728,265 |
306,640 |
$39.98M |
| A0130 |
Noner transport wheelch van |
350,305 |
35,459 |
$13.08M |
| S5131 |
Homemaker service nos /diem |
19,031 |
5,594 |
$7.07M |
| T2003 |
N-et; encounter/trip |
85,361 |
7,689 |
$6.05M |
| A0090 |
Interest escort in non er |
62,232 |
27,645 |
$4.97M |
| S5130 |
Homaker service nos per 15m |
23,834 |
7,485 |
$4.48M |
| S0209 |
Wc van mileage per mi |
276,850 |
31,845 |
$4.44M |
| S5170 |
Homedelivered prepared meal |
279,115 |
19,217 |
$3.66M |
| T2005 |
N-et; stretcher van |
15,254 |
1,445 |
$2.99M |
| S5175 |
Laundry serv,ext,prof,/order |
42,049 |
17,589 |
$2.23M |
| A0080 |
Noninterest escort in non er |
14,453 |
9,086 |
$1.78M |
| S5140 |
Adult foster care per diem |
3,562 |
501 |
$1.19M |
| S5121 |
Chore services per diem |
10,425 |
3,878 |
$1.14M |
| S5102 |
Adult day care per diem |
3,900 |
1,079 |
$1.03M |
| S5161 |
Emer rspns sys serv permonth |
38,065 |
32,816 |
$946K |
| 99213 |
|
12,342 |
10,737 |
$715K |
| T1019 |
Personal care ser per 15 min |
5,766 |
2,071 |
$711K |
| A0428 |
Bls |
3,011 |
692 |
$695K |
| A0110 |
Nonemergency transport bus |
11,254 |
3,763 |
$660K |
| S5135 |
Adult companioncare per 15m |
3,014 |
965 |
$528K |
| T2007 |
Non-emer transport wait time |
9,371 |
4,369 |
$525K |
| A0180 |
Noner transport lodgng recip |
3,678 |
2,975 |
$505K |
| H0046 |
Mental health service, nos |
26,809 |
12,736 |
$443K |
| 99214 |
|
5,251 |
4,472 |
$358K |
| T2001 |
N-et; patient attend/escort |
32,540 |
7,695 |
$314K |
| T2049 |
N-et; stretcher van, mileage |
15,229 |
1,455 |
$301K |
| G0156 |
Hhcp-svs of aide,ea 15 min |
664 |
302 |
$290K |
| T2032 |
Res care, nos waiver/month |
117 |
116 |
$283K |
| S0280 |
Medical home, initial plan |
2,076 |
1,765 |
$256K |
| 97530 |
|
6,047 |
1,508 |
$210K |
| S5165 |
Home modifications per serv |
41 |
39 |
$188K |
| 90837 |
|
2,543 |
931 |
$180K |
| 90460 |
|
4,316 |
4,069 |
$165K |
| A0210 |
Noner transport meals escort |
12,338 |
7,737 |
$155K |
| A0190 |
Noner transport meals recip |
3,358 |
2,457 |
$150K |
| 90834 |
|
3,402 |
1,043 |
$148K |
| T1013 |
Sign lang/oral interpreter |
2,667 |
1,920 |
$136K |
| 97110 |
|
7,337 |
1,830 |
$128K |
| A0380 |
Basic life support mileage |
1,760 |
274 |
$125K |
| 97124 |
|
2,866 |
470 |
$111K |
| T4528 |
Adult size pull-on xl |
1,801 |
1,519 |
$106K |
| E0147 |
Walker variable wheel resist |
891 |
877 |
$92K |
| 99392 |
|
1,022 |
992 |
$92K |
| A0429 |
Bls-emergency |
824 |
680 |
$78K |
| A0170 |
Transport parking fees/tolls |
14,802 |
6,371 |
$77K |
| 99391 |
|
874 |
782 |
$72K |
| 99393 |
|
738 |
696 |
$65K |
| A0425 |
Ground mileage |
2,482 |
1,987 |
$62K |
| H2010 |
Comprehensive med svc 15 min |
8,038 |
156 |
$57K |
| S5120 |
Chore services per 15 min |
949 |
378 |
$52K |
| 97112 |
|
2,885 |
810 |
$51K |
| 99401 |
|
1,767 |
1,467 |
$51K |
| A0427 |
Als1-emergency |
386 |
351 |
$43K |
| B4153 |
Ef hydrolyzed/amino acids |
334 |
279 |
$43K |
| B4150 |
Ef complet w/intact nutrient |
767 |
699 |
$39K |
| T2002 |
N-et; per diem |
7,744 |
1,210 |
$39K |
| 90833 |
|
1,130 |
864 |
$36K |
| V2100 |
Lens spher single plano 4.00 |
474 |
390 |
$36K |
| 90999 |
|
725 |
63 |
$33K |
| T4535 |
Disposable liner/shield/pad |
1,017 |
901 |
$31K |
| S5160 |
Emer response sys instal&tst |
786 |
742 |
$30K |
| 97535 |
|
1,075 |
320 |
$30K |
| E1399 |
Durable medical equipment mi |
695 |
616 |
$26K |
| 97116 |
|
1,840 |
526 |
$23K |
| 99394 |
|
242 |
232 |
$23K |
| 99204 |
|
233 |
217 |
$23K |
| 90792 |
|
226 |
223 |
$22K |
| 93303 |
|
155 |
142 |
$22K |
| 97140 |
|
1,519 |
362 |
$22K |
| G0447 |
Behavior counsel obesity 15m |
1,140 |
1,023 |
$22K |
| T5999 |
Supply, nos |
195 |
48 |
$20K |
| 93306 |
|
86 |
84 |
$17K |
| 99354 |
|
193 |
178 |
$16K |
| E0445 |
Oximeter non-invasive |
66 |
65 |
$16K |
| 99244 |
|
90 |
90 |
$16K |
| 99203 |
|
187 |
178 |
$15K |
| 92587 |
|
893 |
856 |
$15K |
| 80307 |
|
339 |
229 |
$13K |
| A9999 |
Dme supply or accessory, nos |
188 |
139 |
$13K |
| 90471 |
|
689 |
669 |
$13K |
| E0245 |
Tub stool or bench |
1,190 |
1,162 |
$13K |
| G0480 |
Drug test def 1-7 classes |
200 |
134 |
$11K |
| 87804 |
|
991 |
476 |
$11K |
| 87880 |
|
979 |
753 |
$11K |
| 92507 |
|
175 |
37 |
$11K |
| 99212 |
|
293 |
258 |
$11K |
| V2020 |
Vision svcs frames purchases |
81 |
71 |
$11K |
| A4554 |
Disposable underpads |
1,189 |
982 |
$10K |
| T4526 |
Adult size pull-on med |
228 |
166 |
$10K |
| 99058 |
|
568 |
515 |
$10K |
| A0200 |
Noner transport lodgng escrt |
87 |
67 |
$10K |
| V2784 |
Lens polycarb or equal |
78 |
66 |
$8K |
| E1390 |
Oxygen concentrator |
268 |
214 |
$7K |
| 90472 |
|
413 |
147 |
$7K |
| 93000 |
|
399 |
393 |
$6K |
| 92083 |
|
118 |
115 |
$6K |
| 99381 |
|
69 |
62 |
$6K |
| D1208 |
|
609 |
604 |
$6K |
| 93320 |
|
155 |
142 |
$5K |
| 36415 |
|
551 |
329 |
$5K |
| 92552 |
|
211 |
205 |
$5K |
| 94667 |
|
238 |
200 |
$5K |
| 94640 |
|
314 |
264 |
$5K |
| 99188 |
|
424 |
421 |
$5K |
| 94760 |
|
1,761 |
1,593 |
$4K |
| E0156 |
Walker seat attachment |
1,180 |
1,137 |
$4K |
| E0244 |
Toilet seat raised |
273 |
270 |
$4K |
| 99205 |
Prolong outpt/office vis |
26 |
25 |
$4K |
| B4152 |
Ef calorie dense>/=1.5kcal |
103 |
99 |
$4K |
| A4670 |
Automatic bp monitor, dial |
166 |
161 |
$4K |
| E0570 |
Nebulizer with compression |
250 |
244 |
$4K |
| A4927 |
Non-sterile gloves |
555 |
503 |
$4K |
| T4522 |
Adult size brief/diaper med |
80 |
46 |
$3K |
| 90853 |
|
111 |
26 |
$3K |
| E0163 |
Commode chair with fixed arm |
214 |
210 |
$3K |
| E0241 |
Bath tub wall rail |
231 |
223 |
$3K |
| V2755 |
Uv lens/es |
80 |
66 |
$3K |
| 99243 |
|
36 |
34 |
$3K |
| Q3014 |
Telehealth facility fee |
210 |
158 |
$3K |
| A4595 |
Tens suppl 2 lead per month |
103 |
99 |
$3K |
| A6212 |
Foam drg <=16 sq in w/border |
38 |
38 |
$2K |
| K0738 |
Portable gas oxygen system |
237 |
189 |
$2K |
| V2760 |
Scratch resistant coating |
77 |
65 |
$2K |
| 93325 |
|
155 |
143 |
$2K |
| B4154 |
Ef spec metabolic noninherit |
111 |
110 |
$2K |
| E0100 |
Cane adjust/fixed with tip |
322 |
322 |
$2K |
| E0246 |
Transfer tub rail attachment |
51 |
51 |
$2K |
| S9970 |
Health club membership yr |
12 |
12 |
$2K |
| A6219 |
Gauze <= 16 sq in w/border |
138 |
123 |
$2K |
| 92567 |
|
121 |
111 |
$1K |
| 99306 |
Prolong nursin fac eval 15m |
25 |
25 |
$1K |
| A4358 |
Urinary leg or abdomen bag |
145 |
124 |
$1K |
| 99309 |
|
49 |
38 |
$1K |
| 90791 |
|
132 |
42 |
$1K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
13 |
12 |
$966.96 |
| 81002 |
|
325 |
252 |
$932.19 |
| 99308 |
|
62 |
53 |
$900.73 |
| E0305 |
Rails bed side half length |
27 |
27 |
$869.16 |
| S5110 |
Family homecare training 15m |
12 |
12 |
$796.29 |
| D1206 |
|
28 |
24 |
$795.00 |
| E0143 |
Walker folding wheeled w/o s |
102 |
97 |
$776.81 |
| H0020 |
Alcohol and/or drug services |
12,979 |
560 |
$746.46 |
| E0149 |
Heavy duty wheeled walker |
12 |
12 |
$698.88 |
| S9430 |
Pharmacy comp/disp serv |
130 |
129 |
$687.74 |
| 99305 |
|
16 |
15 |
$580.98 |
| 87635 |
|
20 |
16 |
$513.30 |
| 96372 |
|
20 |
12 |
$406.66 |
| A6216 |
Non-sterile gauze<=16 sq in |
302 |
142 |
$374.71 |
| E0105 |
Cane adjust/fixed quad/3 pro |
13 |
12 |
$354.09 |
| 83655 |
|
25 |
25 |
$353.00 |
| A7015 |
Aerosol mask used w nebulize |
222 |
185 |
$333.69 |
| V2744 |
Tint photochromatic lens/es |
12 |
12 |
$319.92 |
| 36416 |
|
73 |
65 |
$310.31 |
| 90674 |
|
13 |
13 |
$269.65 |
| 92015 |
|
34 |
33 |
$268.26 |
| 82962 |
|
181 |
159 |
$262.64 |
| E0210 |
Electric heat pad standard |
13 |
13 |
$262.06 |
| A7003 |
Nebulizer administration set |
88 |
86 |
$233.42 |
| A7005 |
Nondisposable nebulizer set |
46 |
46 |
$228.60 |
| 92340 |
|
25 |
24 |
$227.27 |
| 97162 |
|
12 |
12 |
$219.24 |
| 85018 |
|
79 |
79 |
$217.25 |
| K0002 |
Stnd hemi (low seat) whlchr |
16 |
14 |
$179.79 |
| A7038 |
Pos airway pressure filter |
113 |
113 |
$170.85 |
| 88740 |
|
114 |
77 |
$158.07 |
| 85025 |
|
357 |
267 |
$157.65 |
| 90670 |
|
369 |
346 |
$125.54 |
| A6446 |
Conform band s w>=3" <5"/yd |
42 |
42 |
$120.23 |
| H0049 |
Alcohol/drug screening |
12 |
12 |
$105.36 |
| A4245 |
Alcohol wipes per box |
31 |
29 |
$68.79 |
| E0159 |
Brake for wheeled walker |
23 |
23 |
$57.62 |
| A6402 |
Sterile gauze <= 16 sq in |
42 |
39 |
$55.52 |
| J7611 |
Albuterol non-comp con |
237 |
199 |
$54.48 |
| A4450 |
Non-waterproof tape |
118 |
105 |
$37.73 |
| 90686 |
|
805 |
787 |
$27.28 |
| 99177 |
|
14 |
14 |
$24.88 |
| 90651 |
|
106 |
95 |
$20.00 |
| 90734 |
|
74 |
62 |
$20.00 |
| 90688 |
|
89 |
88 |
$15.44 |
| 80048 |
|
19 |
16 |
$10.68 |
| A4520 |
Incontinence garment anytype |
107 |
91 |
$3.96 |
| A4335 |
Incontinence supply |
36 |
30 |
$2.39 |
| 90461 |
|
166 |
157 |
$0.68 |
| 90680 |
|
180 |
165 |
$0.00 |
| 90716 |
|
47 |
39 |
$0.00 |
| 99000 |
|
27 |
25 |
$0.00 |
| 90698 |
|
171 |
163 |
$0.00 |
| 90656 |
|
40 |
40 |
$0.00 |
| E0248 |
Hdtrans bench w/wo comm open |
15 |
15 |
$0.00 |
| E0247 |
Trans bench w/wo comm open |
12 |
12 |
$0.00 |
| 80053 |
|
123 |
98 |
$0.00 |
| 90723 |
|
64 |
59 |
$0.00 |
| A6260 |
Wound cleanser any type/size |
28 |
24 |
$0.00 |
| 90744 |
|
42 |
39 |
$0.00 |
| G2078 |
Take-home meth |
33 |
26 |
$0.00 |
| 0500F |
|
13 |
13 |
$0.00 |
| 90633 |
|
130 |
124 |
$0.00 |
| 99173 |
|
143 |
140 |
$0.00 |
| 90672 |
|
36 |
35 |
$0.00 |
| 90700 |
|
74 |
74 |
$0.00 |
| A6250 |
Skin seal protect moisturizr |
36 |
31 |
$0.00 |
| 90707 |
|
70 |
62 |
$0.00 |
| 97810 |
|
145 |
61 |
$0.00 |
| 90715 |
|
21 |
17 |
$0.00 |
| 97813 |
|
79 |
28 |
$0.00 |
| 90713 |
|
45 |
45 |
$0.00 |
| 99442 |
|
21 |
19 |
$0.00 |
| 90648 |
|
85 |
80 |
$0.00 |
| 90685 |
|
52 |
49 |
$0.00 |
| 90710 |
|
31 |
26 |
$0.00 |
| 99499 |
|
15 |
13 |
$0.00 |
| G2067 |
Med assist tx meth wk |
568 |
198 |
$0.00 |