| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1017 |
Targeted case management, each 15 minutes |
66,202 |
60,304 |
$12.88M |
| T2004 |
Non-emergency transport; commercial carrier, multi-pass |
25,725 |
22,605 |
$2.86M |
| T2028 |
Specialized supply, not otherwise specified, waiver |
46,854 |
39,531 |
$1.63M |
| V2799 |
Vision item or service, miscellaneous |
2,751 |
2,110 |
$1.20M |
| S5130 |
Homemaker service, nos; per 15 minutes |
3,122 |
2,285 |
$811K |
| S5199 |
Personal care item, nos, each |
5,751 |
4,537 |
$614K |
| T2003 |
Non-emergency transportation; encounter/trip |
4,379 |
3,192 |
$267K |
| T2035 |
Utility services to support medical equipment and assistive technology/devices, waiver |
534 |
371 |
$185K |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
399 |
233 |
$59K |
| S5165 |
Home modifications; per service |
23 |
13 |
$33K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
63 |
30 |
$12K |
| T1016 |
Case management, each 15 minutes |
1,007 |
570 |
$5K |
| A0110 |
Non-emergency transportation and bus, intra or inter state carrier |
31 |
31 |
$1K |