| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult size pull-on xl |
9,820 |
9,709 |
$1.29M |
| T4543 |
Adult disp brief/diap abv xl |
2,374 |
2,349 |
$689K |
| T4537 |
Reusable underpad bed size |
13,716 |
13,564 |
$544K |
| T4535 |
Disposable liner/shield/pad |
10,101 |
10,016 |
$286K |
| T4541 |
Large disposable underpad |
13,690 |
13,549 |
$174K |
| T4527 |
Adult size pull-on lg |
1,498 |
1,483 |
$147K |
| A4927 |
Non-sterile gloves |
5,765 |
5,667 |
$69K |
| T4523 |
Adult size brief/diaper lg |
690 |
689 |
$66K |
| T4524 |
Adult size brief/diaper xl |
291 |
291 |
$25K |
| T4536 |
Reusable pull-on any size |
1,095 |
1,085 |
$20K |
| A5120 |
Skin barrier, wipe or swab |
232 |
164 |
$2K |
| A6530 |
Compression stocking bk18-30 |
14 |
14 |
$519.28 |
| A5512 |
Multi den insert direct form |
58 |
29 |
$186.04 |
| A5500 |
Diab shoe for density insert |
58 |
29 |
$152.92 |