| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| E0603 |
Electric breast pump |
5,524 |
5,331 |
$799K |
| L2630 |
Pelvic control band & belt u |
2,628 |
2,606 |
$435K |
| A4554 |
Disposable underpads |
4,166 |
3,912 |
$263K |
| T4533 |
Youth size brief/diaper |
2,835 |
2,720 |
$206K |
| A4287 |
Disp col sto bag breast milk |
3,679 |
3,651 |
$152K |
| K1005 |
Disp col sto bag breast milk |
3,557 |
3,444 |
$124K |
| L0624 |
Sio panel custom |
889 |
886 |
$115K |
| T4537 |
Reusable underpad bed size |
4,258 |
4,045 |
$108K |
| A6540 |
Gc stocking waistlngth 30-40 |
760 |
754 |
$101K |
| T4539 |
Reuse diaper/brief any size |
3,224 |
3,044 |
$95K |
| T4521 |
Adult size brief/diaper sm |
670 |
639 |
$60K |
| T4524 |
Adult size brief/diaper xl |
430 |
406 |
$58K |
| T4522 |
Adult size brief/diaper med |
602 |
559 |
$55K |
| A6539 |
Gc stocking waistlngth 18-30 |
613 |
610 |
$50K |
| T4540 |
Reusable underpad chair size |
3,213 |
3,033 |
$44K |
| A4927 |
Non-sterile gloves |
4,446 |
4,199 |
$18K |
| T4523 |
Adult size brief/diaper lg |
101 |
97 |
$14K |
| T4535 |
Disposable liner/shield/pad |
347 |
331 |
$12K |
| A6534 |
Gc stocking thighlngth 30-40 |
228 |
228 |
$8K |
| A6533 |
Gc stocking thighlngth 18-30 |
240 |
239 |
$7K |
| L0621 |
Sio flex pelvic/sacr pre ots |
48 |
48 |
$2K |