| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult size pull-on xl |
8,789 |
8,648 |
$1.51M |
| T4541 |
Large disposable underpad |
21,454 |
21,144 |
$1.43M |
| T4527 |
Adult size pull-on lg |
9,647 |
9,510 |
$1.30M |
| T4535 |
Disposable liner/shield/pad |
24,101 |
23,786 |
$1.14M |
| T4526 |
Adult size pull-on med |
2,264 |
2,230 |
$309K |
| A4927 |
Non-sterile gloves |
20,371 |
20,081 |
$187K |
| A6536 |
Gc stocking full lngth 18-30 |
1,486 |
1,459 |
$151K |
| E0240 |
Bath/shower chair |
327 |
316 |
$32K |
| A6530 |
Compression stocking bk18-30 |
418 |
405 |
$27K |
| A6539 |
Gc stocking waistlngth 18-30 |
220 |
211 |
$24K |
| A5500 |
Diab shoe for density insert |
153 |
152 |
$7K |
| A5512 |
Multi den insert direct form |
153 |
152 |
$5K |
| A4670 |
Automatic bp monitor, dial |
71 |
71 |
$4K |
| A4253 |
Blood glucose/reagent strips |
918 |
917 |
$4K |
| L0627 |
Lo sag ri an/pos pnl pre cst |
15 |
12 |
$3K |
| A4259 |
Lancets per box |
916 |
915 |
$345.28 |