| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5190 |
Wellness assessment, performed by non-physician |
1,935 |
1,935 |
$648K |
| H2022 |
Community-based wrap-around services, per diem |
1,476 |
1,476 |
$199K |
| T2003 |
Non-emergency transportation; encounter/trip |
6,767 |
6,718 |
$0.00 |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
569 |
569 |
$0.00 |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
9,879 |
9,879 |
$0.00 |
| T2022 |
Case management, per month |
26,215 |
26,215 |
$0.00 |
| S5120 |
Chore services; per 15 minutes |
4,141 |
4,141 |
$0.00 |
| S5125 |
Attendant care services; per 15 minutes |
3,569 |
3,569 |
$0.00 |