| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5102 |
Day care services, adult; per diem |
3,920 |
3,897 |
$287K |
| T2025 |
Waiver services; not otherwise specified (nos) |
15,284 |
15,170 |
$191K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
78,833 |
5,805 |
$60K |
| T2003 |
Non-emergency transportation; encounter/trip |
4,757 |
4,525 |
$36K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
11,459 |
11,347 |
$30K |
| G9012 |
Other specified case management service not elsewhere classified |
105 |
100 |
$23K |
| T1022 |
Contracted home health agency services, all services provided under contract, per day |
2,019 |
1,961 |
$13K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
2,750 |
2,663 |
$3K |
| S5151 |
Unskilled respite care, not hospice; per diem |
191 |
61 |
$2K |
| 3103 |
|
324 |
310 |
$0.00 |
| T2022 |
Case management, per month |
8,575 |
8,571 |
$0.00 |