| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
26,095 |
23,941 |
$876K |
| X1939 |
|
10,189 |
10,079 |
$648K |
| T5999 |
Supply, nos |
54,076 |
47,309 |
$628K |
| T4534 |
Youth size pull-on |
4,836 |
4,592 |
$550K |
| T4527 |
Adult size pull-on lg |
8,556 |
7,675 |
$487K |
| T4543 |
Adult disp brief/diap abv xl |
3,022 |
2,798 |
$410K |
| T4528 |
Adult size pull-on xl |
5,296 |
5,049 |
$358K |
| T4526 |
Adult size pull-on med |
6,736 |
5,979 |
$355K |
| T4535 |
Disposable liner/shield/pad |
10,274 |
9,761 |
$313K |
| T4523 |
Adult size brief/diaper lg |
2,630 |
2,090 |
$245K |
| T4522 |
Adult size brief/diaper med |
2,870 |
2,342 |
$218K |
| T4524 |
Adult size brief/diaper xl |
1,664 |
1,421 |
$195K |
| T2028 |
Special supply, nos waiver |
1,686 |
1,601 |
$167K |
| A4927 |
Non-sterile gloves |
9,889 |
6,654 |
$139K |
| T4525 |
Adult size pull-on sm |
2,156 |
2,029 |
$137K |
| X1922 |
|
231 |
218 |
$30K |
| T4533 |
Youth size brief/diaper |
243 |
235 |
$28K |
| X1915 |
|
362 |
353 |
$25K |
| T4530 |
Ped size brief/diaper lg |
41 |
41 |
$4K |
| T4521 |
Adult size brief/diaper sm |
50 |
46 |
$4K |
| T2029 |
Special med equip, noswaiver |
13 |
13 |
$2K |