| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A6250 |
Skin seal protect moisturizr |
7,621 |
7,002 |
$1.01M |
| T4523 |
Adult size brief/diaper lg |
2,647 |
2,456 |
$384K |
| A4554 |
Disposable underpads |
6,127 |
5,755 |
$343K |
| T4524 |
Adult size brief/diaper xl |
1,898 |
1,778 |
$304K |
| A4245 |
Alcohol wipes per box |
9,423 |
8,635 |
$265K |
| A4772 |
Blood glucose test strips |
2,193 |
2,071 |
$197K |
| T4522 |
Adult size brief/diaper med |
1,858 |
1,714 |
$183K |
| T4529 |
Ped size brief/diaper sm/med |
1,304 |
1,266 |
$132K |
| T4530 |
Ped size brief/diaper lg |
1,079 |
1,055 |
$104K |
| T4521 |
Adult size brief/diaper sm |
861 |
825 |
$99K |
| A4927 |
Non-sterile gloves |
5,597 |
5,200 |
$79K |
| T4535 |
Disposable liner/shield/pad |
996 |
944 |
$74K |
| A6221 |
Gauze > 48 sq in w/border |
519 |
481 |
$37K |
| A4215 |
Sterile needle |
1,736 |
1,650 |
$10K |
| A4670 |
Automatic bp monitor, dial |
82 |
80 |
$8K |
| E2101 |
Bld glucose monitor w lance |
26 |
25 |
$3K |
| A6530 |
Compression stocking bk18-30 |
27 |
25 |
$2K |
| S5199 |
Personal care item nos each |
25 |
24 |
$1K |
| A4259 |
Lancets per box |
50 |
48 |
$224.26 |
| B4160 |
Ef ped caloric dense>/=0.7kc |
293 |
284 |
$0.00 |
| A4335 |
Incontinence supply |
1,741 |
1,692 |
$0.00 |
| T4532 |
Ped size pull-on lg |
13 |
12 |
$0.00 |