| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1017 |
Targeted case management |
301,070 |
55,380 |
$14.12M |
| V2799 |
Misc vision item or service |
3,486 |
3,089 |
$1.68M |
| T2028 |
Special supply, nos waiver |
15,360 |
14,749 |
$992K |
| S5150 |
Unskilled respite care /15m |
956 |
660 |
$457K |
| T2004 |
N-et; commerc carrier pass |
4,513 |
4,265 |
$188K |
| T2021 |
Day habil waiver per 15 min |
262 |
220 |
$159K |
| S5130 |
Homaker service nos per 15m |
842 |
535 |
$151K |
| T1016 |
Case management |
9,505 |
2,180 |
$135K |
| T2003 |
N-et; encounter/trip |
944 |
723 |
$126K |
| H2021 |
Com wrap-around sv, 15 min |
393 |
301 |
$111K |
| H2019 |
Ther behav svc, per 15 min |
428 |
340 |
$92K |
| 97124 |
|
122 |
116 |
$54K |
| S5151 |
Unskilled respitecare /diem |
127 |
97 |
$54K |
| T1019 |
Personal care ser per 15 min |
192 |
169 |
$45K |
| G0176 |
Opps/php/iop; activity thrpy |
119 |
97 |
$30K |
| T2036 |
Camp overnite waiver/session |
17 |
15 |
$9K |
| T2035 |
Utility services waiver |
14 |
12 |
$4K |