| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
24,529 |
24,409 |
$551K |
| T4523 |
Adult size brief/diaper lg |
9,597 |
9,578 |
$538K |
| A4554 |
Disposable underpads |
23,738 |
23,586 |
$485K |
| T4524 |
Adult size brief/diaper xl |
5,127 |
5,002 |
$345K |
| L3030 |
Foot arch support remov prem |
2,587 |
2,560 |
$278K |
| T4522 |
Adult size brief/diaper med |
4,091 |
4,088 |
$195K |
| L3216 |
Orthoped ladies shoes dpth i |
1,690 |
1,675 |
$120K |
| T4539 |
Reuse diaper/brief any size |
3,301 |
3,230 |
$90K |
| T4543 |
Adult disp brief/diap abv xl |
715 |
715 |
$82K |
| L3221 |
Orthopedic mens shoes dpth i |
528 |
513 |
$44K |
| T4537 |
Reusable underpad bed size |
1,327 |
1,314 |
$43K |
| A4670 |
Automatic bp monitor, dial |
123 |
123 |
$5K |
| A4253 |
Blood glucose/reagent strips |
109 |
109 |
$3K |
| A4927 |
Non-sterile gloves |
440 |
431 |
$2K |
| A4259 |
Lancets per box |
24 |
24 |
$21.84 |
| A4245 |
Alcohol wipes per box |
13 |
13 |
$20.85 |