| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
5,828 |
5,738 |
$901K |
| A4554 |
Disposable underpads |
20,380 |
20,134 |
$744K |
| T4528 |
Adult size pull-on xl |
3,659 |
3,615 |
$689K |
| T4526 |
Adult size pull-on med |
5,102 |
4,993 |
$637K |
| T4535 |
Disposable liner/shield/pad |
6,036 |
5,981 |
$252K |
| T4523 |
Adult size brief/diaper lg |
1,965 |
1,933 |
$227K |
| T4544 |
Adlt disp und/pull on abv xl |
517 |
492 |
$143K |
| A4335 |
Incontinence supply |
22,467 |
22,190 |
$123K |
| T4522 |
Adult size brief/diaper med |
857 |
839 |
$97K |
| T4524 |
Adult size brief/diaper xl |
559 |
552 |
$96K |
| E0240 |
Bath/shower chair |
168 |
163 |
$86K |
| K0003 |
Lightweight wheelchair |
602 |
594 |
$29K |
| A6250 |
Skin seal protect moisturizr |
4,619 |
4,585 |
$24K |
| A4670 |
Automatic bp monitor, dial |
171 |
170 |
$10K |
| A4595 |
Tens suppl 2 lead per month |
380 |
365 |
$7K |
| A6533 |
Gc stocking thighlngth 18-30 |
16 |
16 |
$4K |
| K0195 |
Elevating whlchair leg rests |
111 |
111 |
$471.74 |