| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
26,901 |
17,891 |
$1.82M |
| A4554 |
Disposable underpads |
65,890 |
44,719 |
$1.59M |
| E0603 |
Electric breast pump |
7,732 |
7,522 |
$1.06M |
| T4532 |
Ped size pull-on lg |
18,930 |
12,819 |
$1.03M |
| T4527 |
Adult size pull-on lg |
9,731 |
6,855 |
$909K |
| T4526 |
Adult size pull-on med |
10,006 |
6,928 |
$713K |
| T4528 |
Adult size pull-on xl |
6,770 |
4,674 |
$597K |
| A4927 |
Non-sterile gloves |
22,751 |
17,710 |
$597K |
| T4544 |
Adlt disp und/pull on abv xl |
4,478 |
3,479 |
$537K |
| T4533 |
Youth size brief/diaper |
7,144 |
4,813 |
$428K |
| T4530 |
Ped size brief/diaper lg |
5,784 |
4,007 |
$265K |
| T4525 |
Adult size pull-on sm |
2,334 |
1,692 |
$166K |
| L0621 |
Sio flex pelvic/sacr pre ots |
2,636 |
2,603 |
$161K |
| A4353 |
Intermittent urinary cath |
193 |
133 |
$134K |
| A6530 |
Compression stocking bk18-30 |
1,552 |
1,312 |
$68K |
| B4154 |
Ef spec metabolic noninherit |
593 |
520 |
$65K |
| T4535 |
Disposable liner/shield/pad |
1,947 |
1,748 |
$60K |
| A4467 |
Belt strap sleev grmnt cover |
1,730 |
1,035 |
$59K |
| T4522 |
Adult size brief/diaper med |
1,066 |
668 |
$53K |
| T4523 |
Adult size brief/diaper lg |
804 |
498 |
$47K |
| A6212 |
Foam drg <=16 sq in w/border |
316 |
312 |
$41K |
| B4150 |
Ef complet w/intact nutrient |
490 |
408 |
$37K |
| A4930 |
Sterile, gloves per pair |
278 |
277 |
$36K |
| T4521 |
Adult size brief/diaper sm |
563 |
315 |
$23K |
| L2630 |
Pelvic control band & belt u |
107 |
98 |
$19K |
| T4524 |
Adult size brief/diaper xl |
280 |
157 |
$17K |
| T4531 |
Ped size pull-on sm/med |
130 |
117 |
$14K |
| A4335 |
Incontinence supply |
1,849 |
1,514 |
$8K |
| A4351 |
Straight tip urine catheter |
37 |
24 |
$8K |
| A4520 |
Incontinence garment anytype |
121 |
103 |
$3K |
| T4543 |
Adult disp brief/diap abv xl |
17 |
17 |
$3K |
| A6245 |
Hydrogel drg <= 16 in w/bdr |
82 |
76 |
$3K |
| T5999 |
Supply, nos |
215 |
202 |
$801.36 |