| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4525 |
Adult size pull-on sm |
6,741 |
6,680 |
$712K |
| T4527 |
Adult size pull-on lg |
3,879 |
3,720 |
$523K |
| T4537 |
Reusable underpad bed size |
18,006 |
17,790 |
$457K |
| T4526 |
Adult size pull-on med |
4,036 |
3,910 |
$445K |
| T4541 |
Large disposable underpad |
11,002 |
10,919 |
$367K |
| T4530 |
Ped size brief/diaper lg |
3,719 |
3,688 |
$355K |
| A4927 |
Non-sterile gloves |
12,178 |
11,658 |
$314K |
| T4535 |
Disposable liner/shield/pad |
10,517 |
10,353 |
$277K |
| T4528 |
Adult size pull-on xl |
1,895 |
1,750 |
$248K |
| T4532 |
Ped size pull-on lg |
2,285 |
2,275 |
$232K |
| B4152 |
Ef calorie dense>/=1.5kcal |
1,352 |
1,236 |
$208K |
| B4150 |
Ef complet w/intact nutrient |
1,923 |
1,758 |
$196K |
| T4522 |
Adult size brief/diaper med |
1,809 |
1,789 |
$188K |
| T4521 |
Adult size brief/diaper sm |
1,550 |
1,535 |
$131K |
| T4523 |
Adult size brief/diaper lg |
909 |
902 |
$99K |
| T4529 |
Ped size brief/diaper sm/med |
659 |
657 |
$56K |
| T4533 |
Youth size brief/diaper |
281 |
278 |
$26K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
74 |
74 |
$20K |
| A4253 |
Blood glucose/reagent strips |
1,963 |
1,802 |
$16K |
| A4239 |
Non-adju cgm supply allow |
52 |
50 |
$13K |
| T4531 |
Ped size pull-on sm/med |
84 |
84 |
$8K |
| A4215 |
Sterile needle |
68 |
63 |
$2K |
| B4100 |
Food thickener oral |
21 |
14 |
$514.80 |
| A4259 |
Lancets per box |
292 |
272 |
$243.42 |