| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4335 |
Incontinence supply |
3,495 |
3,473 |
$73K |
| T2029 |
Special med equip, noswaiver |
1,124 |
1,111 |
$70K |
| A4520 |
Incontinence garment anytype |
185 |
183 |
$6K |
| T4527 |
Adult size pull-on lg |
1,370 |
1,350 |
$293.28 |
| T4535 |
Disposable liner/shield/pad |
1,013 |
999 |
$249.92 |
| A4554 |
Disposable underpads |
3,180 |
3,161 |
$71.40 |
| A6250 |
Skin seal protect moisturizr |
577 |
576 |
$40.00 |
| A4927 |
Non-sterile gloves |
1,628 |
1,616 |
$17.50 |
| S5199 |
Personal care item nos each |
4,060 |
4,035 |
$1.14 |
| T4526 |
Adult size pull-on med |
1,323 |
1,306 |
$0.00 |
| T4528 |
Adult size pull-on xl |
515 |
506 |
$0.00 |
| S9999 |
Sales tax |
920 |
917 |
$0.00 |
| T4544 |
Adlt disp und/pull on abv xl |
61 |
59 |
$0.00 |
| T4524 |
Adult size brief/diaper xl |
121 |
120 |
$0.00 |
| T4522 |
Adult size brief/diaper med |
111 |
111 |
$0.00 |
| T4525 |
Adult size pull-on sm |
124 |
123 |
$0.00 |
| T4543 |
Adult disp brief/diap abv xl |
77 |
74 |
$0.00 |
| T4523 |
Adult size brief/diaper lg |
210 |
209 |
$0.00 |