| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2022 |
Case management, per month |
1,311 |
1,311 |
$278K |
| T2025 |
Waiver service, nos |
2,151 |
2,141 |
$126K |
| S5161 |
Emer rspns sys serv permonth |
1,277 |
1,268 |
$12K |
| S5162 |
Emer rspns system purchase |
309 |
309 |
$7K |
| T2028 |
Special supply, nos waiver |
429 |
429 |
$5K |
| T2003 |
N-et; encounter/trip |
309 |
308 |
$2K |
| S5199 |
Personal care item nos each |
74 |
74 |
$782.12 |
| T1999 |
Noc retail items andsupplies |
99 |
78 |
$0.00 |
| S5102 |
Adult day care per diem |
552 |
550 |
$0.00 |
| T1019 |
Personal care ser per 15 min |
300 |
277 |
$0.00 |
| T2001 |
N-et; patient attend/escort |
57 |
32 |
$0.00 |