| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5125 |
Attendant care services; per 15 minutes |
10,890 |
531 |
$958K |
| T1016 |
Case management, each 15 minutes |
8,483 |
836 |
$187K |
| 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 |
98 |
63 |
$4K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
166 |
102 |
$3K |
| A4554 |
Disposable underpads, all sizes |
15 |
13 |
$449.03 |