| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
2,135 |
2,063 |
$132K |
| T4528 |
Adult size pull-on xl |
790 |
775 |
$130K |
| T4535 |
Disposable liner/shield/pad |
2,251 |
2,172 |
$98K |
| T4527 |
Adult size pull-on lg |
565 |
553 |
$78K |
| A4927 |
Non-sterile gloves |
2,077 |
1,986 |
$62K |
| A6541 |
Gc stocking waistlngth 40+ |
299 |
285 |
$50K |
| T4526 |
Adult size pull-on med |
345 |
328 |
$46K |
| T4543 |
Adult disp brief/diap abv xl |
132 |
121 |
$31K |
| A4930 |
Sterile, gloves per pair |
619 |
584 |
$22K |
| A5500 |
Diab shoe for density insert |
324 |
232 |
$13K |
| A6534 |
Gc stocking thighlngth 30-40 |
86 |
83 |
$8K |
| A4216 |
Sterile water/saline, 10 ml |
106 |
106 |
$4K |
| B4035 |
Enteral feed supp pump per d |
12 |
12 |
$3K |
| A5512 |
Multi den insert direct form |
148 |
82 |
$2K |