| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
12,304 |
10,005 |
$670K |
| T4528 |
Adult size pull-on xl |
8,556 |
6,779 |
$494K |
| T4526 |
Adult size pull-on med |
7,630 |
6,315 |
$410K |
| A4927 |
Non-sterile gloves |
6,879 |
6,543 |
$392K |
| T4535 |
Disposable liner/shield/pad |
4,731 |
3,669 |
$167K |
| T4544 |
Adlt disp und/pull on abv xl |
1,083 |
818 |
$68K |
| T4537 |
Reusable underpad bed size |
4,724 |
4,321 |
$63K |
| T4523 |
Adult size brief/diaper lg |
1,044 |
801 |
$57K |
| T4541 |
Large disposable underpad |
1,462 |
1,338 |
$43K |
| T4522 |
Adult size brief/diaper med |
232 |
198 |
$11K |
| T4524 |
Adult size brief/diaper xl |
219 |
137 |
$7K |
| T4525 |
Adult size pull-on sm |
106 |
82 |
$5K |
| J7620 |
Albuterol ipratrop non-comp |
14 |
14 |
$39.99 |
| G0008 |
Admin influenza virus vac |
2,584 |
2,540 |
$0.00 |
| 90686 |
|
1,104 |
1,104 |
$0.00 |
| 0064A |
|
466 |
466 |
$0.00 |
| 90480 |
|
369 |
348 |
$0.00 |
| 90694 |
|
679 |
658 |
$0.00 |
| 0011A |
|
610 |
610 |
$0.00 |
| 90674 |
|
316 |
316 |
$0.00 |
| G0009 |
Admin pneumococcal vaccine |
14 |
14 |
$0.00 |
| 0012A |
|
535 |
535 |
$0.00 |
| 0134A |
|
402 |
402 |
$0.00 |
| 0004A |
|
251 |
251 |
$0.00 |
| 90653 |
|
358 |
337 |
$0.00 |
| 91322 |
|
369 |
348 |
$0.00 |
| 90661 |
|
52 |
50 |
$0.00 |