| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
4,250 |
3,674 |
$290K |
| T4544 |
Adlt disp und/pull on abv xl |
1,850 |
1,625 |
$272K |
| A4927 |
Non-sterile gloves |
12,826 |
11,030 |
$232K |
| T4526 |
Adult size pull-on med |
4,262 |
3,671 |
$214K |
| T4535 |
Disposable liner/shield/pad |
5,377 |
4,545 |
$207K |
| T4528 |
Adult size pull-on xl |
3,110 |
2,706 |
$204K |
| A4554 |
Disposable underpads |
8,696 |
7,511 |
$189K |
| S5161 |
Emer rspns sys serv permonth |
2,757 |
2,345 |
$90K |
| A4649 |
Surgical supplies |
3,400 |
2,957 |
$68K |
| T4523 |
Adult size brief/diaper lg |
456 |
420 |
$33K |
| T4524 |
Adult size brief/diaper xl |
347 |
304 |
$30K |
| T4525 |
Adult size pull-on sm |
565 |
499 |
$28K |
| T4534 |
Youth size pull-on |
345 |
273 |
$23K |
| E1399 |
Durable medical equipment mi |
462 |
340 |
$22K |
| T4522 |
Adult size brief/diaper med |
262 |
229 |
$18K |
| T4543 |
Adult disp brief/diap abv xl |
103 |
82 |
$12K |
| T2029 |
Special med equip, noswaiver |
87 |
66 |
$1K |