| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4524 |
Adult size brief/diaper xl |
1,966 |
1,904 |
$258K |
| A4554 |
Disposable underpads |
3,506 |
3,385 |
$217K |
| T4535 |
Disposable liner/shield/pad |
2,978 |
2,904 |
$113K |
| T4539 |
Reuse diaper/brief any size |
3,123 |
3,037 |
$100K |
| T4523 |
Adult size brief/diaper lg |
741 |
718 |
$91K |
| T4537 |
Reusable underpad bed size |
2,022 |
1,948 |
$65K |
| L3410 |
Shoe metatarsal bar between |
682 |
470 |
$39K |
| L3030 |
Foot arch support remov prem |
945 |
461 |
$39K |
| L3310 |
Shoe lift elev heel/sole neo |
397 |
247 |
$23K |
| T4540 |
Reusable underpad chair size |
1,308 |
1,250 |
$22K |
| L3217 |
Ladies shoes hightop depth i |
428 |
206 |
$21K |
| L3222 |
Mens shoes hightop depth inl |
191 |
93 |
$11K |
| L3340 |
Shoe wedge sach |
205 |
168 |
$10K |
| A4927 |
Non-sterile gloves |
2,059 |
1,988 |
$9K |
| L3206 |
Hightop w/ supp/pronator chi |
170 |
84 |
$4K |
| S8101 |
Spacer with mask |
26 |
25 |
$1K |
| T4522 |
Adult size brief/diaper med |
12 |
12 |
$1K |
| A7005 |
Nondisposable nebulizer set |
26 |
25 |
$392.40 |