| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
30,852 |
28,792 |
$2.51M |
| T4526 |
Adult size pull-on med |
28,762 |
26,664 |
$2.19M |
| T4528 |
Adult size pull-on xl |
13,100 |
11,994 |
$1.12M |
| A4554 |
Disposable underpads |
70,183 |
63,829 |
$1.01M |
| T4525 |
Adult size pull-on sm |
7,377 |
6,738 |
$594K |
| A5120 |
Skin barrier, wipe or swab |
82,710 |
75,518 |
$577K |
| T4535 |
Disposable liner/shield/pad |
10,035 |
9,385 |
$390K |
| T4543 |
Adult disp brief/diap abv xl |
2,817 |
2,449 |
$376K |
| S5199 |
Personal care item nos each |
10,299 |
8,731 |
$280K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
2,247 |
2,128 |
$272K |
| T4523 |
Adult size brief/diaper lg |
3,426 |
3,125 |
$270K |
| T4524 |
Adult size brief/diaper xl |
2,536 |
2,277 |
$239K |
| A4927 |
Non-sterile gloves |
36,640 |
31,905 |
$225K |
| T4534 |
Youth size pull-on |
1,659 |
1,543 |
$219K |
| T4522 |
Adult size brief/diaper med |
1,922 |
1,799 |
$153K |
| B4150 |
Ef complet w/intact nutrient |
1,039 |
853 |
$70K |
| T4532 |
Ped size pull-on lg |
180 |
173 |
$33K |
| B4152 |
Ef calorie dense>/=1.5kcal |
302 |
299 |
$23K |
| B4154 |
Ef spec metabolic noninherit |
658 |
456 |
$15K |
| T4531 |
Ped size pull-on sm/med |
64 |
62 |
$6K |
| T4544 |
Adlt disp und/pull on abv xl |
26 |
24 |
$3K |