| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2022 |
Case management, per month |
5,173 |
2,155 |
$823K |
| T2025 |
Waiver services; not otherwise specified (nos) |
2,679 |
1,356 |
$483K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
913 |
757 |
$87K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
921 |
793 |
$84K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
709 |
618 |
$53K |
| T4541 |
Incontinence product, disposable underpad, large, each |
3,217 |
2,776 |
$42K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
475 |
400 |
$35K |
| A4927 |
Gloves, non-sterile, per 100 |
2,801 |
2,565 |
$30K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
269 |
252 |
$26K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
217 |
202 |
$23K |
| 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 |
340 |
285 |
$23K |
| B4100 |
Food thickener, administered orally, per ounce |
42 |
38 |
$15K |
| K0001 |
Standard wheelchair |
275 |
256 |
$5K |
| E0260 |
Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress |
119 |
105 |
$4K |