| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
8,309 |
7,569 |
$684K |
| A6250 |
Skin seal protect moisturizr |
7,951 |
7,225 |
$646K |
| T4523 |
Adult size brief/diaper lg |
3,138 |
2,907 |
$332K |
| T4535 |
Disposable liner/shield/pad |
4,391 |
3,990 |
$331K |
| T4524 |
Adult size brief/diaper xl |
2,803 |
2,568 |
$311K |
| S5199 |
Personal care item nos each |
5,509 |
4,997 |
$303K |
| A4927 |
Non-sterile gloves |
11,322 |
10,187 |
$268K |
| T4522 |
Adult size brief/diaper med |
2,322 |
2,137 |
$182K |
| T4543 |
Adult disp brief/diap abv xl |
1,125 |
1,033 |
$177K |
| A4245 |
Alcohol wipes per box |
906 |
829 |
$24K |
| A4670 |
Automatic bp monitor, dial |
42 |
25 |
$4K |
| A4928 |
Surgical mask |
229 |
205 |
$2K |
| E0245 |
Tub stool or bench |
14 |
14 |
$1K |
| E0244 |
Toilet seat raised |
12 |
12 |
$539.40 |