| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Large disposable underpad |
7,164 |
7,118 |
$477K |
| T4535 |
Disposable liner/shield/pad |
4,597 |
4,552 |
$381K |
| T4523 |
Adult size brief/diaper lg |
2,692 |
2,674 |
$373K |
| T4522 |
Adult size brief/diaper med |
2,571 |
2,559 |
$273K |
| T4527 |
Adult size pull-on lg |
2,818 |
2,802 |
$244K |
| T4524 |
Adult size brief/diaper xl |
1,575 |
1,560 |
$192K |
| T4526 |
Adult size pull-on med |
2,803 |
2,790 |
$180K |
| T4528 |
Adult size pull-on xl |
1,608 |
1,599 |
$138K |
| A6250 |
Skin seal protect moisturizr |
1,402 |
1,374 |
$21K |
| K0003 |
Lightweight wheelchair |
222 |
222 |
$21K |
| E0245 |
Tub stool or bench |
204 |
203 |
$11K |
| A4335 |
Incontinence supply |
821 |
812 |
$10K |
| E0143 |
Walker folding wheeled w/o s |
92 |
91 |
$6K |
| K0195 |
Elevating whlchair leg rests |
90 |
90 |
$2K |
| T4537 |
Reusable underpad bed size |
12 |
12 |
$349.08 |