| Code | Description | Claims | Beneficiaries | Total Paid |
| T1023 |
Program intake assessment |
30,334 |
26,760 |
$7.12M |
| A6250 |
Skin seal protect moisturizr |
4,850 |
3,700 |
$398K |
| A4554 |
Disposable underpads |
3,051 |
2,873 |
$192K |
| A6260 |
Wound cleanser any type/size |
3,358 |
2,960 |
$145K |
| T4524 |
Adult size brief/diaper xl |
649 |
606 |
$87K |
| A4927 |
Non-sterile gloves |
4,504 |
4,151 |
$80K |
| T4522 |
Adult size brief/diaper med |
694 |
652 |
$63K |
| T4523 |
Adult size brief/diaper lg |
415 |
390 |
$50K |
| A5120 |
Skin barrier, wipe or swab |
4,259 |
3,959 |
$42K |
| T4535 |
Disposable liner/shield/pad |
694 |
631 |
$38K |
| T4543 |
Adult disp brief/diap abv xl |
97 |
91 |
$19K |