| Code | Description | Claims | Beneficiaries | Total Paid |
| T4541 |
Large disposable underpad |
15,061 |
15,058 |
$788K |
| T4526 |
Adult size pull-on med |
11,347 |
11,343 |
$536K |
| T4535 |
Disposable liner/shield/pad |
8,775 |
8,560 |
$437K |
| T4527 |
Adult size pull-on lg |
3,020 |
3,020 |
$171K |
| T4522 |
Adult size brief/diaper med |
2,451 |
2,445 |
$136K |
| T4537 |
Reusable underpad bed size |
1,539 |
1,538 |
$83K |
| T4523 |
Adult size brief/diaper lg |
1,193 |
1,193 |
$77K |
| T4525 |
Adult size pull-on sm |
1,157 |
1,157 |
$55K |
| E0245 |
Tub stool or bench |
90 |
90 |
$5K |
| T4536 |
Reusable pull-on any size |
334 |
334 |
$4K |
| A6250 |
Skin seal protect moisturizr |
159 |
159 |
$2K |
| T4528 |
Adult size pull-on xl |
26 |
26 |
$2K |
| A4335 |
Incontinence supply |
131 |
131 |
$2K |
| K0001 |
Standard wheelchair |
479 |
479 |
$2K |
| E0143 |
Walker folding wheeled w/o s |
47 |
47 |
$566.16 |
| E0156 |
Walker seat attachment |
30 |
30 |
$105.32 |
| E0100 |
Cane adjust/fixed with tip |
12 |
12 |
$89.82 |