| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4245 |
Alcohol wipes per box |
4,869 |
4,783 |
$348K |
| A6250 |
Skin seal protect moisturizr |
3,055 |
3,004 |
$246K |
| A4554 |
Disposable underpads |
3,366 |
3,293 |
$203K |
| T4523 |
Adult size brief/diaper lg |
1,649 |
1,633 |
$200K |
| A4927 |
Non-sterile gloves |
3,157 |
3,082 |
$50K |
| A4928 |
Surgical mask |
2,308 |
2,275 |
$40K |
| S5199 |
Personal care item nos each |
1,541 |
1,511 |
$36K |
| T4524 |
Adult size brief/diaper xl |
296 |
289 |
$36K |
| T4535 |
Disposable liner/shield/pad |
401 |
401 |
$31K |
| T4543 |
Adult disp brief/diap abv xl |
107 |
107 |
$17K |
| A4216 |
Sterile water/saline, 10 ml |
209 |
206 |
$11K |
| K0739 |
Repair/svc dme non-oxygen eq |
64 |
62 |
$5K |
| A6402 |
Sterile gauze <= 16 sq in |
138 |
135 |
$3K |
| E2313 |
Pwc harness, expand control |
13 |
12 |
$3K |
| A4369 |
Skin barrier liquid per oz |
48 |
48 |
$2K |