| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
9,683 |
9,454 |
$442K |
| T4527 |
Adult size pull-on lg |
4,623 |
4,543 |
$395K |
| T4526 |
Adult size pull-on med |
4,094 |
4,037 |
$322K |
| T4528 |
Adult size pull-on xl |
2,121 |
2,076 |
$182K |
| T4544 |
Adlt disp und/pull on abv xl |
512 |
482 |
$166K |
| T4541 |
Large disposable underpad |
4,529 |
4,451 |
$163K |
| A5120 |
Skin barrier, wipe or swab |
6,485 |
6,152 |
$74K |
| T4537 |
Reusable underpad bed size |
1,916 |
1,905 |
$53K |
| T4525 |
Adult size pull-on sm |
671 |
659 |
$44K |
| T4523 |
Adult size brief/diaper lg |
299 |
294 |
$28K |
| T4524 |
Adult size brief/diaper xl |
213 |
209 |
$19K |
| A4927 |
Non-sterile gloves |
6,074 |
5,954 |
$17K |
| T4522 |
Adult size brief/diaper med |
187 |
180 |
$11K |
| T4543 |
Adult disp brief/diap abv xl |
48 |
45 |
$11K |
| A6250 |
Skin seal protect moisturizr |
1,384 |
1,378 |
$4K |
| B4154 |
Ef spec metabolic noninherit |
54 |
54 |
$1K |
| B4150 |
Ef complet w/intact nutrient |
84 |
80 |
$1K |
| B4152 |
Ef calorie dense>/=1.5kcal |
45 |
39 |
$866.32 |
| A4335 |
Incontinence supply |
1,336 |
1,331 |
$583.99 |
| A4405 |
Nonpectin based ostomy paste |
424 |
424 |
$293.94 |
| A6216 |
Non-sterile gauze<=16 sq in |
17 |
16 |
$36.70 |