| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
7,281 |
7,221 |
$526K |
| T4541 |
Large disposable underpad |
8,086 |
8,057 |
$493K |
| T4527 |
Adult size pull-on lg |
2,426 |
2,414 |
$167K |
| T4523 |
Adult size brief/diaper lg |
1,987 |
1,984 |
$165K |
| T4526 |
Adult size pull-on med |
2,589 |
2,582 |
$141K |
| A4239 |
Non-adju cgm supply allow |
1,708 |
1,679 |
$88K |
| A6250 |
Skin seal protect moisturizr |
5,112 |
5,086 |
$84K |
| T4536 |
Reusable pull-on any size |
5,810 |
5,791 |
$76K |
| L0639 |
Lso s/c shell/panel prefab |
367 |
362 |
$74K |
| T4522 |
Adult size brief/diaper med |
410 |
410 |
$36K |
| A4335 |
Incontinence supply |
4,863 |
4,844 |
$33K |
| T4528 |
Adult size pull-on xl |
330 |
329 |
$26K |
| T4524 |
Adult size brief/diaper xl |
241 |
241 |
$26K |
| T4537 |
Reusable underpad bed size |
695 |
692 |
$24K |
| L1833 |
Ko adj jnt pos r sup pre ots |
218 |
132 |
$22K |
| L1832 |
Ko adj jnt pos r sup pre cst |
206 |
123 |
$20K |
| T4525 |
Adult size pull-on sm |
435 |
433 |
$18K |
| A4927 |
Non-sterile gloves |
1,063 |
1,059 |
$11K |
| E2103 |
Non-adju cgm receiver/mon |
113 |
113 |
$8K |
| L2397 |
Suspension sleeve lower ext |
283 |
163 |
$5K |
| L0648 |
Lso sag r an/pos pnl pre ots |
26 |
26 |
$4K |
| L0637 |
Lso sc r ant/pos pnl pre cst |
13 |
13 |
$2K |
| L0650 |
Lso sc r ant/pos pnl pre ots |
12 |
12 |
$2K |
| K0553 |
Ther cgm supply allowance |
32 |
32 |
$1K |
| K0554 |
Ther cgm receiver/monitor |
26 |
26 |
$1K |
| E0143 |
Walker folding wheeled w/o s |
30 |
30 |
$377.17 |