| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| W0140 |
|
333 |
146 |
$279K |
| T4527 |
Adult size pull-on lg |
2,695 |
2,665 |
$269K |
| T4526 |
Adult size pull-on med |
2,019 |
2,006 |
$191K |
| T4528 |
Adult size pull-on xl |
1,520 |
1,509 |
$162K |
| E1399 |
Durable medical equipment mi |
51 |
40 |
$148K |
| T4541 |
Large disposable underpad |
5,461 |
5,414 |
$114K |
| W1895 |
|
4,465 |
2,846 |
$107K |
| T4535 |
Disposable liner/shield/pad |
2,070 |
2,048 |
$99K |
| T4537 |
Reusable underpad bed size |
1,531 |
1,515 |
$61K |
| T4544 |
Adlt disp und/pull on abv xl |
247 |
246 |
$46K |
| A4927 |
Non-sterile gloves |
2,808 |
2,758 |
$30K |
| A4456 |
Adhesive remover, wipes |
2,203 |
1,793 |
$16K |
| W0137 |
|
31 |
31 |
$6K |
| T4525 |
Adult size pull-on sm |
64 |
64 |
$6K |
| T4543 |
Adult disp brief/diap abv xl |
12 |
12 |
$3K |
| T4524 |
Adult size brief/diaper xl |
26 |
26 |
$3K |
| K0739 |
Repair/svc dme non-oxygen eq |
17 |
15 |
$2K |
| T4523 |
Adult size brief/diaper lg |
12 |
12 |
$1K |
| A4335 |
Incontinence supply |
38 |
37 |
$407.00 |