| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
26,272 |
25,024 |
$1.70M |
| T4527 |
Adult size pull-on lg |
10,253 |
9,803 |
$1.12M |
| T4535 |
Disposable liner/shield/pad |
20,839 |
19,833 |
$891K |
| T4526 |
Adult size pull-on med |
7,892 |
7,574 |
$840K |
| T4528 |
Adult size pull-on xl |
6,392 |
6,120 |
$818K |
| T4544 |
Adlt disp und/pull on abv xl |
2,987 |
2,779 |
$555K |
| A4927 |
Non-sterile gloves |
29,424 |
28,016 |
$423K |
| T4543 |
Adult disp brief/diap abv xl |
1,134 |
1,071 |
$204K |
| T4524 |
Adult size brief/diaper xl |
1,384 |
1,333 |
$162K |
| T4523 |
Adult size brief/diaper lg |
1,308 |
1,235 |
$116K |
| T4522 |
Adult size brief/diaper med |
992 |
951 |
$82K |
| T4525 |
Adult size pull-on sm |
427 |
400 |
$34K |
| E0240 |
Bath/shower chair |
128 |
126 |
$13K |
| A4670 |
Automatic bp monitor, dial |
96 |
95 |
$6K |