| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
13,744 |
13,196 |
$1.19M |
| T4523 |
Adult size brief/diaper lg |
5,877 |
5,622 |
$771K |
| S5199 |
Personal care item nos each |
11,803 |
11,249 |
$574K |
| T4524 |
Adult size brief/diaper xl |
4,224 |
4,042 |
$549K |
| A6250 |
Skin seal protect moisturizr |
11,788 |
11,194 |
$417K |
| A4927 |
Non-sterile gloves |
18,324 |
17,426 |
$410K |
| T4522 |
Adult size brief/diaper med |
3,419 |
3,284 |
$328K |
| T4543 |
Adult disp brief/diap abv xl |
1,831 |
1,730 |
$301K |
| T4535 |
Disposable liner/shield/pad |
2,874 |
2,714 |
$217K |
| A5120 |
Skin barrier, wipe or swab |
4,583 |
4,336 |
$51K |
| T4526 |
Adult size pull-on med |
291 |
280 |
$45K |
| A4772 |
Blood glucose test strips |
180 |
172 |
$29K |
| T4541 |
Large disposable underpad |
404 |
382 |
$19K |
| A4245 |
Alcohol wipes per box |
998 |
931 |
$11K |
| A4670 |
Automatic bp monitor, dial |
99 |
73 |
$7K |
| T4527 |
Adult size pull-on lg |
26 |
24 |
$4K |
| A6402 |
Sterile gauze <= 16 sq in |
54 |
51 |
$3K |
| E0274 |
Over-bed table |
31 |
15 |
$2K |
| K0003 |
Lightweight wheelchair |
43 |
36 |
$941.17 |
| A4259 |
Lancets per box |
101 |
96 |
$161.73 |