| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5102 |
Adult day care per diem |
5,168 |
5,156 |
$154K |
| T2025 |
Waiver service, nos |
12,264 |
12,181 |
$59K |
| S5161 |
Emer rspns sys serv permonth |
5,906 |
5,895 |
$28K |
| S5151 |
Unskilled respitecare /diem |
561 |
192 |
$13K |
| S5120 |
Chore services per 15 min |
718 |
223 |
$5K |
| T1999 |
Noc retail items andsupplies |
1,189 |
206 |
$4K |
| T1022 |
Contracted services per day |
697 |
676 |
$4K |
| T1013 |
Sign lang/oral interpreter |
58 |
52 |
$845.00 |
| T2028 |
Special supply, nos waiver |
47 |
46 |
$654.86 |
| T2022 |
Case management, per month |
8,431 |
8,403 |
$0.00 |