| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
1,212 |
1,018 |
$71K |
| T4541 |
Large disposable underpad |
2,175 |
1,882 |
$69K |
| T4522 |
Adult size brief/diaper med |
666 |
612 |
$62K |
| T4526 |
Adult size pull-on med |
838 |
715 |
$55K |
| T4523 |
Adult size brief/diaper lg |
350 |
280 |
$38K |
| T4527 |
Adult size pull-on lg |
570 |
459 |
$33K |
| T4535 |
Disposable liner/shield/pad |
811 |
709 |
$22K |
| A6402 |
Sterile gauze <= 16 sq in |
224 |
207 |
$12K |
| T4533 |
Youth size brief/diaper |
122 |
117 |
$11K |
| A4385 |
Ost skn barrier sld ext wear |
99 |
86 |
$5K |
| T4528 |
Adult size pull-on xl |
55 |
51 |
$5K |
| T4524 |
Adult size brief/diaper xl |
12 |
12 |
$2K |
| A4409 |
Ost skn barr convex <=4 sq i |
12 |
12 |
$2K |
| A4452 |
Waterproof tape |
130 |
127 |
$2K |
| A5120 |
Skin barrier, wipe or swab |
335 |
312 |
$2K |
| A4456 |
Adhesive remover, wipes |
136 |
132 |
$2K |
| A4670 |
Automatic bp monitor, dial |
33 |
24 |
$1K |
| E0570 |
Nebulizer with compression |
14 |
12 |
$868.72 |
| A6248 |
Hydrogel drsg gel filler |
13 |
12 |
$596.81 |
| A4406 |
Pectin based ostomy paste |
13 |
12 |
$248.14 |