| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1016 |
Case management, each 15 minutes |
34,546 |
12,035 |
$3.89M |
| T2041 |
Supports brokerage, self-directed, waiver; per 15 minutes |
3,517 |
2,033 |
$654K |
| A4554 |
Disposable underpads, all sizes |
1,038 |
993 |
$72K |
| 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 |
1,047 |
800 |
$48K |
| 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 |
1,069 |
741 |
$40K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
422 |
405 |
$31K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
420 |
400 |
$28K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
600 |
427 |
$22K |
| A4927 |
Gloves, non-sterile, per 100 |
689 |
653 |
$17K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
284 |
246 |
$16K |
| S5170 |
Home delivered meals, including preparation; per meal |
1,796 |
107 |
$9K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
13 |
12 |
$1K |
| 99199 |
Unlisted special service, procedure or report |
12 |
12 |
$57.12 |