| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/pad |
4,695 |
3,431 |
$303K |
| T2028 |
Special supply, nos waiver |
4,576 |
2,789 |
$172K |
| T4527 |
Adult size pull-on lg |
1,477 |
1,078 |
$127K |
| T4537 |
Reusable underpad bed size |
3,612 |
2,681 |
$118K |
| T4526 |
Adult size pull-on med |
1,630 |
1,111 |
$112K |
| T4528 |
Adult size pull-on xl |
1,214 |
859 |
$100K |
| A4927 |
Non-sterile gloves |
5,526 |
4,131 |
$86K |
| T4541 |
Large disposable underpad |
1,885 |
1,339 |
$56K |
| T4543 |
Adult disp brief/diap abv xl |
52 |
36 |
$7K |
| T4522 |
Adult size brief/diaper med |
23 |
12 |
$1K |
| T4540 |
Reusable underpad chair size |
80 |
34 |
$963.23 |
| A6530 |
Compression stocking bk18-30 |
29 |
26 |
$672.50 |