| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4532 |
Ped size pull-on lg |
75,738 |
74,212 |
$9.54M |
| B4160 |
Ef ped caloric dense>/=0.7kc |
34,877 |
32,885 |
$4.86M |
| B4100 |
Food thickener oral |
37,614 |
35,421 |
$2.67M |
| B4150 |
Ef complet w/intact nutrient |
14,647 |
13,383 |
$2.07M |
| T4526 |
Adult size pull-on med |
8,766 |
8,505 |
$942K |
| B4152 |
Ef calorie dense>/=1.5kcal |
3,142 |
2,968 |
$646K |
| T4527 |
Adult size pull-on lg |
5,162 |
5,044 |
$592K |
| T4529 |
Ped size brief/diaper sm/med |
4,155 |
4,093 |
$439K |
| T4530 |
Ped size brief/diaper lg |
3,755 |
3,712 |
$437K |
| T4533 |
Youth size brief/diaper |
3,843 |
3,738 |
$401K |
| T4522 |
Adult size brief/diaper med |
3,436 |
3,289 |
$390K |
| T4531 |
Ped size pull-on sm/med |
3,062 |
3,012 |
$361K |
| T4525 |
Adult size pull-on sm |
3,055 |
2,939 |
$249K |
| T4521 |
Adult size brief/diaper sm |
2,150 |
2,073 |
$215K |
| A4554 |
Disposable underpads |
4,047 |
3,945 |
$191K |
| T4528 |
Adult size pull-on xl |
1,726 |
1,700 |
$187K |
| T4523 |
Adult size brief/diaper lg |
1,005 |
971 |
$112K |
| T4535 |
Disposable liner/shield/pad |
355 |
334 |
$23K |
| T4544 |
Adlt disp und/pull on abv xl |
180 |
179 |
$17K |
| A4927 |
Non-sterile gloves |
1,392 |
1,352 |
$11K |
| B4161 |
Ef ped hydrolyzed/amino acid |
40 |
40 |
$8K |
| B4155 |
Ef incomplete/modular |
41 |
41 |
$910.08 |