| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
3,587 |
3,500 |
$221K |
| T4524 |
Adult size brief/diaper xl |
1,381 |
1,338 |
$181K |
| T4539 |
Reuse diaper/brief any size |
2,900 |
2,820 |
$93K |
| T4535 |
Disposable liner/shield/pad |
2,779 |
2,721 |
$86K |
| T4537 |
Reusable underpad bed size |
2,225 |
2,160 |
$73K |
| T4543 |
Adult disp brief/diap abv xl |
225 |
225 |
$69K |
| T4523 |
Adult size brief/diaper lg |
677 |
658 |
$62K |
| T4540 |
Reusable underpad chair size |
952 |
911 |
$13K |
| A4927 |
Non-sterile gloves |
3,005 |
2,933 |
$13K |
| S8101 |
Spacer with mask |
75 |
71 |
$4K |
| L3030 |
Foot arch support remov prem |
21 |
13 |
$1K |
| A7005 |
Nondisposable nebulizer set |
77 |
72 |
$1K |
| A7015 |
Aerosol mask used w nebulize |
45 |
41 |
$43.87 |