| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult size brief/diaper lg |
9,783 |
9,771 |
$684K |
| A4554 |
Disposable underpads |
21,012 |
20,960 |
$580K |
| T4524 |
Adult size brief/diaper xl |
7,174 |
7,167 |
$523K |
| T4535 |
Disposable liner/shield/pad |
13,683 |
13,668 |
$365K |
| T4543 |
Adult disp brief/diap abv xl |
1,432 |
1,429 |
$173K |
| T4522 |
Adult size brief/diaper med |
2,743 |
2,739 |
$136K |
| L3030 |
Foot arch support remov prem |
1,265 |
1,114 |
$126K |
| T4539 |
Reuse diaper/brief any size |
2,369 |
2,363 |
$63K |
| T4537 |
Reusable underpad bed size |
1,950 |
1,935 |
$56K |
| L3216 |
Orthoped ladies shoes dpth i |
511 |
463 |
$34K |
| A4927 |
Non-sterile gloves |
1,433 |
1,424 |
$6K |
| L3221 |
Orthopedic mens shoes dpth i |
51 |
42 |
$4K |
| A4402 |
Lubricant per ounce |
24 |
24 |
$138.65 |