| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
16,256 |
15,928 |
$1.28M |
| T4524 |
Adult size brief/diaper xl |
7,505 |
7,341 |
$1.25M |
| T4537 |
Reusable underpad bed size |
15,906 |
15,568 |
$508K |
| T4523 |
Adult size brief/diaper lg |
3,410 |
3,313 |
$500K |
| T4539 |
Reuse diaper/brief any size |
11,038 |
10,755 |
$353K |
| T4533 |
Youth size brief/diaper |
3,318 |
3,297 |
$317K |
| T4521 |
Adult size brief/diaper sm |
725 |
722 |
$82K |
| T4535 |
Disposable liner/shield/pad |
918 |
899 |
$39K |
| L3030 |
Foot arch support remov prem |
318 |
144 |
$19K |
| L3000 |
Ft insert ucb berkeley shell |
55 |
27 |
$14K |
| A4927 |
Non-sterile gloves |
2,898 |
2,841 |
$13K |
| T4522 |
Adult size brief/diaper med |
77 |
76 |
$8K |
| E0570 |
Nebulizer with compression |
217 |
217 |
$4K |
| L3216 |
Orthoped ladies shoes dpth i |
61 |
29 |
$2K |
| A7005 |
Nondisposable nebulizer set |
12 |
12 |
$196.20 |