| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4524 |
Adult size brief/diaper xl |
17,206 |
16,854 |
$1.97M |
| A4554 |
Disposable underpads |
29,805 |
29,318 |
$1.39M |
| T4523 |
Adult size brief/diaper lg |
8,523 |
8,484 |
$664K |
| T4535 |
Disposable liner/shield/pad |
20,445 |
20,256 |
$606K |
| T4539 |
Reuse diaper/brief any size |
16,054 |
15,626 |
$451K |
| T4537 |
Reusable underpad bed size |
11,724 |
11,376 |
$342K |
| T4522 |
Adult size brief/diaper med |
2,606 |
2,582 |
$176K |
| T4540 |
Reusable underpad chair size |
8,193 |
7,906 |
$133K |
| L3030 |
Foot arch support remov prem |
859 |
708 |
$77K |
| A4927 |
Non-sterile gloves |
5,740 |
5,484 |
$28K |
| T4530 |
Ped size brief/diaper lg |
277 |
274 |
$24K |
| T4543 |
Adult disp brief/diap abv xl |
141 |
141 |
$19K |
| L3216 |
Orthoped ladies shoes dpth i |
245 |
207 |
$17K |
| T4521 |
Adult size brief/diaper sm |
136 |
133 |
$14K |
| A5500 |
Diab shoe for density insert |
24 |
24 |
$478.96 |
| A6530 |
Compression stocking bk18-30 |
12 |
12 |
$370.26 |
| A5512 |
Multi den insert direct form |
12 |
12 |
$189.14 |