| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult disp brief/diap abv xl |
5,921 |
5,879 |
$1.25M |
| A4554 |
Disposable underpads |
16,296 |
16,222 |
$727K |
| T4524 |
Adult size brief/diaper xl |
5,203 |
5,176 |
$526K |
| T4535 |
Disposable liner/shield/pad |
11,052 |
11,029 |
$360K |
| T4523 |
Adult size brief/diaper lg |
4,334 |
4,324 |
$342K |
| T4537 |
Reusable underpad bed size |
7,264 |
7,199 |
$217K |
| T4539 |
Reuse diaper/brief any size |
8,127 |
8,062 |
$212K |
| T4522 |
Adult size brief/diaper med |
2,662 |
2,638 |
$201K |
| L3030 |
Foot arch support remov prem |
1,969 |
1,447 |
$159K |
| T4540 |
Reusable underpad chair size |
5,290 |
5,255 |
$86K |
| L3217 |
Ladies shoes hightop depth i |
479 |
365 |
$46K |
| L3216 |
Orthoped ladies shoes dpth i |
323 |
272 |
$21K |
| A4927 |
Non-sterile gloves |
4,031 |
3,989 |
$18K |
| L3221 |
Orthopedic mens shoes dpth i |
33 |
26 |
$2K |
| A6539 |
Gc stocking waistlngth 18-30 |
12 |
12 |
$1K |
| K0001 |
Standard wheelchair |
186 |
184 |
$839.88 |
| K0195 |
Elevating whlchair leg rests |
143 |
142 |
$213.27 |
| E0570 |
Nebulizer with compression |
12 |
12 |
$15.07 |