| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S5125 |
Attendant care services; per 15 minutes |
82,067 |
3,275 |
$6.22M |
| T1016 |
Case management, each 15 minutes |
22,242 |
5,668 |
$1.67M |
| T2041 |
Supports brokerage, self-directed, waiver; per 15 minutes |
4,684 |
1,640 |
$488K |
| 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 |
1,073 |
866 |
$66K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,039 |
1,751 |
$60K |
| A4554 |
Disposable underpads, all sizes |
2,348 |
2,068 |
$46K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
598 |
514 |
$30K |
| 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 |
507 |
419 |
$28K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
121 |
120 |
$8K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
52 |
39 |
$2K |
| S5170 |
Home delivered meals, including preparation; per meal |
210 |
14 |
$621.92 |
| A4927 |
Gloves, non-sterile, per 100 |
29 |
24 |
$315.32 |