| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads |
4,431 |
4,420 |
$198K |
| T4523 |
Adult size brief/diaper lg |
1,923 |
1,910 |
$180K |
| T4535 |
Disposable liner/shield/pad |
4,360 |
4,341 |
$150K |
| T4524 |
Adult size brief/diaper xl |
907 |
907 |
$83K |
| T4539 |
Reuse diaper/brief any size |
2,435 |
2,416 |
$73K |
| L3030 |
Foot arch support remov prem |
656 |
480 |
$42K |
| T4537 |
Reusable underpad bed size |
1,131 |
1,129 |
$35K |
| L3216 |
Orthoped ladies shoes dpth i |
347 |
223 |
$18K |
| A4927 |
Non-sterile gloves |
2,656 |
2,650 |
$12K |
| T4522 |
Adult size brief/diaper med |
64 |
64 |
$4K |
| T4540 |
Reusable underpad chair size |
206 |
206 |
$3K |