| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1016 |
Case management, each 15 minutes |
10,915 |
4,681 |
$1.46M |
| A0120 |
Non-emergency transportation: mini-bus, mountain area transports, or other transportation systems |
34,612 |
3,460 |
$1.21M |
| S5125 |
Attendant care services; per 15 minutes |
5,114 |
251 |
$381K |
| A0130 |
Non-emergency transportation: wheelchair van |
5,214 |
300 |
$124K |
| A4554 |
Disposable underpads, all sizes |
643 |
594 |
$26K |
| B4150 |
Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
203 |
158 |
$10K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
45 |
37 |
$2K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
75 |
48 |
$917.93 |
| 99199 |
Unlisted special service, procedure or report |
19 |
15 |
$90.24 |