| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1016 |
Case management, each 15 minutes |
16,805 |
7,225 |
$2.16M |
| S5125 |
Attendant care services; per 15 minutes |
20,514 |
955 |
$1.62M |
| T2041 |
Supports brokerage, self-directed, waiver; per 15 minutes |
3,941 |
2,504 |
$815K |
| 99509 |
Home visit for assistance with activities of daily living and personal care |
12,465 |
709 |
$608K |
| A4554 |
Disposable underpads, all sizes |
1,106 |
993 |
$35K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
375 |
348 |
$28K |
| B4154 |
Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit |
617 |
510 |
$25K |
| 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 |
521 |
453 |
$19K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
534 |
469 |
$12K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
88 |
75 |
$5K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
17 |
12 |
$745.15 |
| 99199 |
Unlisted special service, procedure or report |
15 |
15 |
$72.40 |