| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1019 |
Personal care ser per 15 min |
204,360 |
12,916 |
$28.44M |
| S5125 |
Attendant care service /15m |
5,532 |
304 |
$755K |
| S5161 |
Emer rspns sys serv permonth |
15,089 |
15,003 |
$440K |
| T4523 |
Adult size brief/diaper lg |
1,948 |
1,893 |
$241K |
| T4524 |
Adult size brief/diaper xl |
1,678 |
1,606 |
$216K |
| E1399 |
Durable medical equipment mi |
1,067 |
445 |
$128K |
| A4554 |
Disposable underpads |
2,710 |
2,664 |
$124K |
| T4535 |
Disposable liner/shield/pad |
2,340 |
2,301 |
$111K |
| T4522 |
Adult size brief/diaper med |
1,206 |
1,161 |
$104K |
| G0162 |
Hhc rn e&m plan svs, 15 min |
714 |
691 |
$95K |
| S0215 |
Nonemerg transp mileage |
1,825 |
587 |
$84K |
| A0130 |
Noner transport wheelch van |
1,014 |
370 |
$65K |
| S0209 |
Wc van mileage per mi |
1,013 |
369 |
$32K |
| T4537 |
Reusable underpad bed size |
600 |
600 |
$24K |
| A0100 |
Nonemergency transport taxi |
1,827 |
589 |
$21K |
| A4927 |
Non-sterile gloves |
2,129 |
2,098 |
$15K |
| T4540 |
Reusable underpad chair size |
229 |
229 |
$8K |
| S5160 |
Emer response sys instal&tst |
122 |
118 |
$3K |
| E0570 |
Nebulizer with compression |
196 |
196 |
$3K |
| K0739 |
Repair/svc dme non-oxygen eq |
14 |
12 |
$1K |