| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
40,535 |
34,691 |
$1.39M |
| T5999 |
Supply, nos |
96,904 |
66,662 |
$1.34M |
| T2028 |
Special supply, nos waiver |
5,938 |
5,539 |
$907K |
| T4528 |
Adult size pull-on xl |
11,136 |
8,670 |
$839K |
| T4534 |
Youth size pull-on |
8,073 |
7,204 |
$774K |
| T4543 |
Adult disp brief/diap abv xl |
4,917 |
3,801 |
$715K |
| T4527 |
Adult size pull-on lg |
12,361 |
9,872 |
$710K |
| T4522 |
Adult size brief/diaper med |
11,101 |
7,935 |
$700K |
| T4526 |
Adult size pull-on med |
9,516 |
7,817 |
$525K |
| T4523 |
Adult size brief/diaper lg |
6,381 |
4,281 |
$514K |
| A4927 |
Non-sterile gloves |
41,792 |
28,996 |
$479K |
| T4535 |
Disposable liner/shield/pad |
13,755 |
11,977 |
$435K |
| T4525 |
Adult size pull-on sm |
4,638 |
3,618 |
$290K |
| T4524 |
Adult size brief/diaper xl |
2,931 |
2,344 |
$278K |
| X1915 |
|
2,715 |
2,640 |
$270K |
| X1939 |
|
3,587 |
3,572 |
$234K |
| X1922 |
|
471 |
456 |
$41K |
| T4521 |
Adult size brief/diaper sm |
190 |
148 |
$13K |
| T4530 |
Ped size brief/diaper lg |
126 |
126 |
$12K |
| B9998 |
Enteral supp not otherwise c |
16 |
13 |
$5K |
| T4533 |
Youth size brief/diaper |
45 |
43 |
$5K |
| T2029 |
Special med equip, noswaiver |
12 |
12 |
$2K |