| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult size brief/diaper lg |
8,204 |
8,192 |
$782K |
| A4554 |
Disposable underpads |
10,759 |
10,743 |
$372K |
| T4539 |
Reuse diaper/brief any size |
10,632 |
10,615 |
$249K |
| T4537 |
Reusable underpad bed size |
9,857 |
9,843 |
$245K |
| T4522 |
Adult size brief/diaper med |
2,778 |
2,776 |
$184K |
| T4535 |
Disposable liner/shield/pad |
4,676 |
4,670 |
$139K |
| L3030 |
Foot arch support remov prem |
521 |
510 |
$48K |
| A6539 |
Gc stocking waistlngth 18-30 |
40 |
40 |
$5K |
| L3020 |
Foot longitud/metatarsal sup |
15 |
12 |
$2K |
| L3217 |
Ladies shoes hightop depth i |
14 |
14 |
$2K |
| L3215 |
Orthopedic ftwear ladies oxf |
13 |
13 |
$1K |