| Code | Description | Claims | Beneficiaries | Total Paid |
| T2022 |
Case management, per month |
24,660 |
13,480 |
$5.30M |
| G9012 |
Other specified case management service not elsewhere classified |
3,623 |
3,274 |
$152K |
| G9008 |
Coordinated care fee, physician coordinated care oversight services |
18 |
17 |
$300.06 |
| T2028 |
Specialized supply, not otherwise specified, waiver |
930 |
930 |
$0.00 |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
794 |
794 |
$0.00 |
| T2003 |
Non-emergency transportation; encounter/trip |
26 |
26 |
$0.00 |