| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4522 |
Adult size brief/diaper med |
6,814 |
6,799 |
$600K |
| A4554 |
Disposable underpads |
8,504 |
8,490 |
$387K |
| T4523 |
Adult size brief/diaper lg |
3,421 |
3,416 |
$306K |
| T4539 |
Reuse diaper/brief any size |
10,012 |
9,992 |
$268K |
| T4537 |
Reusable underpad bed size |
8,090 |
8,081 |
$259K |
| T4535 |
Disposable liner/shield/pad |
5,423 |
5,415 |
$189K |
| L3030 |
Foot arch support remov prem |
4,087 |
2,043 |
$165K |
| L3215 |
Orthopedic ftwear ladies oxf |
1,507 |
755 |
$69K |
| L3219 |
Orthopedic mens shoes oxford |
359 |
179 |
$19K |
| L3216 |
Orthoped ladies shoes dpth i |
238 |
119 |
$7K |
| L3002 |
Foot insert plastazote or eq |
52 |
26 |
$4K |
| L3221 |
Orthopedic mens shoes dpth i |
50 |
25 |
$2K |
| A4927 |
Non-sterile gloves |
55 |
51 |
$236.60 |