| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult size brief/diaper lg |
2,466 |
2,466 |
$307K |
| T4535 |
Disposable liner/shield/pad |
5,335 |
5,335 |
$281K |
| A4554 |
Disposable underpads |
3,619 |
3,614 |
$207K |
| T4522 |
Adult size brief/diaper med |
2,199 |
2,199 |
$193K |
| T4524 |
Adult size brief/diaper xl |
1,137 |
1,137 |
$145K |
| T4521 |
Adult size brief/diaper sm |
486 |
486 |
$42K |
| T4537 |
Reusable underpad bed size |
997 |
994 |
$35K |
| L0631 |
Lso sag r an/pos pnl pre cst |
50 |
50 |
$26K |
| A4402 |
Lubricant per ounce |
1,945 |
1,942 |
$15K |
| A4927 |
Non-sterile gloves |
3,455 |
3,455 |
$15K |
| L1971 |
Afo w/ankle joint, prefab |
28 |
14 |
$5K |
| E0240 |
Bath/shower chair |
75 |
75 |
$3K |
| E0241 |
Bath tub wall rail |
41 |
41 |
$1K |
| T4539 |
Reuse diaper/brief any size |
12 |
12 |
$357.90 |
| A4335 |
Incontinence supply |
4,138 |
4,132 |
$0.00 |