| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2022 |
Case management, per month |
89,827 |
74,413 |
$10.00M |
| T2025 |
Waiver services; not otherwise specified (nos) |
4,987 |
4,267 |
$392K |
| 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 |
1,756 |
1,480 |
$143K |
| T2003 |
Non-emergency transportation; encounter/trip |
3,617 |
909 |
$58K |
| A0130 |
Non-emergency transportation: wheelchair van |
1,943 |
356 |
$58K |
| A0425 |
Ground mileage, per statute mile |
1,620 |
537 |
$46K |