| Code | Description | Claims | Beneficiaries | Total Paid |
| T4535 |
Disposable liner/shield/pad |
62,041 |
58,981 |
$2.29M |
| T4541 |
Large disposable underpad |
57,076 |
56,900 |
$1.99M |
| T4527 |
Adult size pull-on lg |
25,777 |
25,662 |
$1.47M |
| T4528 |
Adult size pull-on xl |
18,420 |
18,358 |
$1.11M |
| T4526 |
Adult size pull-on med |
23,088 |
23,004 |
$1.02M |
| T4523 |
Adult size brief/diaper lg |
2,882 |
2,877 |
$170K |
| T4525 |
Adult size pull-on sm |
4,059 |
4,046 |
$169K |
| A9900 |
Supply/accessory/service |
8,881 |
8,881 |
$73K |
| T4524 |
Adult size brief/diaper xl |
1,122 |
1,122 |
$59K |
| T4522 |
Adult size brief/diaper med |
685 |
679 |
$26K |
| A4335 |
Incontinence supply |
4,149 |
4,025 |
$23K |
| T4544 |
Adlt disp und/pull on abv xl |
322 |
321 |
$23K |
| A4520 |
Incontinence garment anytype |
2,076 |
2,048 |
$22K |
| A4927 |
Non-sterile gloves |
880 |
781 |
$8K |
| T4536 |
Reusable pull-on any size |
466 |
460 |
$5K |
| T4537 |
Reusable underpad bed size |
18 |
18 |
$425.40 |
| A4554 |
Disposable underpads |
37 |
37 |
$348.57 |
| A6250 |
Skin seal protect moisturizr |
91 |
91 |
$261.25 |