| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2028 |
Special supply, nos waiver |
2,173 |
1,819 |
$271K |
| T4528 |
Adult size pull-on xl |
1,294 |
1,239 |
$143K |
| T4527 |
Adult size pull-on lg |
1,335 |
1,277 |
$135K |
| T4523 |
Adult size brief/diaper lg |
1,356 |
1,295 |
$114K |
| T4526 |
Adult size pull-on med |
1,405 |
1,307 |
$106K |
| T4535 |
Disposable liner/shield/pad |
1,154 |
1,117 |
$64K |
| T4522 |
Adult size brief/diaper med |
647 |
628 |
$47K |
| A4927 |
Non-sterile gloves |
1,782 |
1,680 |
$30K |
| T4541 |
Large disposable underpad |
1,314 |
1,272 |
$30K |
| T2029 |
Special med equip, noswaiver |
113 |
86 |
$25K |
| T4537 |
Reusable underpad bed size |
172 |
165 |
$6K |
| T4534 |
Youth size pull-on |
37 |
36 |
$4K |
| B4160 |
Ef ped caloric dense>/=0.7kc |
17 |
12 |
$3K |
| A4357 |
Bedside drainage bag |
17 |
13 |
$144.16 |