| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5105 |
Day care services, center-based; services not included in program fee, per diem |
5,614 |
601 |
$416K |
| S5102 |
Day care services, adult; per diem |
2,415 |
308 |
$284K |
| S5101 |
Day care services, adult; per half day |
4,011 |
434 |
$271K |
| A0100 |
Non-emergency transportation; taxi |
3,949 |
434 |
$113K |
| A0110 |
Non-emergency transportation and bus, intra or inter state carrier |
3,143 |
367 |
$66K |
| S9977 |
Meals, per diem, not otherwise specified |
287 |
64 |
$2K |
| T2003 |
Non-emergency transportation; encounter/trip |
110 |
37 |
$0.00 |