| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E1399 |
Durable medical equipment mi |
26,230 |
13,308 |
$3.91M |
| T4534 |
Youth size pull-on |
1,320 |
1,281 |
$300K |
| T4535 |
Disposable liner/shield/pad |
2,477 |
2,398 |
$189K |
| T4541 |
Large disposable underpad |
2,609 |
2,450 |
$157K |
| T4526 |
Adult size pull-on med |
700 |
680 |
$146K |
| A5120 |
Skin barrier, wipe or swab |
2,280 |
2,176 |
$142K |
| T4527 |
Adult size pull-on lg |
971 |
964 |
$134K |
| T4530 |
Ped size brief/diaper lg |
653 |
637 |
$133K |
| T4522 |
Adult size brief/diaper med |
415 |
406 |
$91K |
| T4528 |
Adult size pull-on xl |
382 |
359 |
$82K |
| T4532 |
Ped size pull-on lg |
428 |
425 |
$75K |
| B4150 |
Ef complet w/intact nutrient |
261 |
260 |
$73K |
| T4521 |
Adult size brief/diaper sm |
378 |
375 |
$70K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
134 |
131 |
$54K |
| T4525 |
Adult size pull-on sm |
205 |
198 |
$48K |
| T4523 |
Adult size brief/diaper lg |
143 |
142 |
$34K |
| A4927 |
Non-sterile gloves |
590 |
566 |
$30K |
| T4537 |
Reusable underpad bed size |
559 |
551 |
$25K |
| T4531 |
Ped size pull-on sm/med |
76 |
76 |
$15K |
| T4533 |
Youth size brief/diaper |
46 |
46 |
$7K |
| B4100 |
Food thickener oral |
14 |
12 |
$1K |