| Code | Description | Claims | Beneficiaries | Total Paid |
| T4535 |
Disposable liner/shield/pad |
3,744 |
3,541 |
$350K |
| T4527 |
Adult size pull-on lg |
2,011 |
1,905 |
$282K |
| T4526 |
Adult size pull-on med |
2,082 |
1,903 |
$282K |
| T4541 |
Large disposable underpad |
5,861 |
5,496 |
$252K |
| T4528 |
Adult size pull-on xl |
1,315 |
1,225 |
$181K |
| T4534 |
Youth size pull-on |
715 |
695 |
$115K |
| T4530 |
Ped size brief/diaper lg |
500 |
480 |
$88K |
| T4522 |
Adult size brief/diaper med |
483 |
459 |
$69K |
| A4670 |
Automatic bp monitor, dial |
718 |
707 |
$61K |
| T4523 |
Adult size brief/diaper lg |
320 |
302 |
$41K |
| T4544 |
Adlt disp und/pull on abv xl |
88 |
81 |
$11K |
| A4927 |
Non-sterile gloves |
244 |
240 |
$5K |
| A6530 |
Compression stocking bk18-30 |
82 |
65 |
$4K |
| T4524 |
Adult size brief/diaper xl |
15 |
12 |
$2K |
| L3908 |
Who cock-up nonmolde pre ots |
43 |
24 |
$1K |
| A6402 |
Sterile gauze <= 16 sq in |
12 |
12 |
$82.24 |