| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
10,486 |
10,269 |
$491K |
| T4523 |
Adult size brief/diaper lg |
3,955 |
3,894 |
$363K |
| T4524 |
Adult size brief/diaper xl |
2,587 |
2,519 |
$246K |
| T4535 |
Disposable liner/shield/pad |
7,112 |
7,081 |
$233K |
| T4522 |
Adult size brief/diaper med |
2,990 |
2,925 |
$204K |
| T4537 |
Reusable underpad bed size |
3,381 |
3,246 |
$103K |
| L3030 |
Foot arch support remov prem |
1,446 |
730 |
$91K |
| T4539 |
Reuse diaper/brief any size |
2,413 |
2,375 |
$71K |
| T4543 |
Adult disp brief/diap abv xl |
232 |
232 |
$50K |
| L3000 |
Ft insert ucb berkeley shell |
136 |
67 |
$30K |
| A4927 |
Non-sterile gloves |
4,765 |
4,598 |
$21K |
| L3216 |
Orthoped ladies shoes dpth i |
370 |
185 |
$16K |
| T4540 |
Reusable underpad chair size |
885 |
800 |
$12K |
| L3221 |
Orthopedic mens shoes dpth i |
246 |
114 |
$12K |
| E1399 |
Durable medical equipment mi |
1,519 |
1,518 |
$10K |
| L3215 |
Orthopedic ftwear ladies oxf |
86 |
60 |
$8K |
| A4335 |
Incontinence supply |
602 |
602 |
$4K |
| L2275 |
Plastic mod low ext pad/line |
33 |
17 |
$4K |
| A4402 |
Lubricant per ounce |
464 |
447 |
$2K |
| L3217 |
Ladies shoes hightop depth i |
26 |
12 |
$2K |
| A4670 |
Automatic bp monitor, dial |
12 |
12 |
$585.00 |