| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult size pull-on xl |
4,142 |
4,071 |
$502K |
| T4543 |
Adult disp brief/diap abv xl |
1,378 |
1,360 |
$391K |
| T4537 |
Reusable underpad bed size |
9,934 |
9,700 |
$387K |
| T4527 |
Adult size pull-on lg |
3,896 |
3,802 |
$386K |
| T4535 |
Disposable liner/shield/pad |
9,062 |
8,894 |
$295K |
| T4526 |
Adult size pull-on med |
1,721 |
1,660 |
$149K |
| T4541 |
Large disposable underpad |
10,954 |
10,709 |
$143K |
| A4927 |
Non-sterile gloves |
7,350 |
7,184 |
$88K |
| T4536 |
Reusable pull-on any size |
1,463 |
1,455 |
$34K |
| A5120 |
Skin barrier, wipe or swab |
856 |
574 |
$6K |
| A5500 |
Diab shoe for density insert |
113 |
94 |
$1K |
| A5512 |
Multi den insert direct form |
113 |
94 |
$692.46 |