| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
36,691 |
14,260 |
$965K |
| T4526 |
Adult size pull-on med |
37,087 |
14,410 |
$879K |
| A5120 |
Skin barrier, wipe or swab |
96,355 |
36,903 |
$457K |
| T4528 |
Adult size pull-on xl |
16,714 |
6,333 |
$451K |
| A4554 |
Disposable underpads |
77,409 |
29,061 |
$426K |
| T4535 |
Disposable liner/shield/pad |
19,364 |
6,439 |
$216K |
| T4523 |
Adult size brief/diaper lg |
6,228 |
2,090 |
$134K |
| T4543 |
Adult disp brief/diap abv xl |
2,519 |
973 |
$118K |
| T4524 |
Adult size brief/diaper xl |
5,266 |
1,760 |
$115K |
| T4522 |
Adult size brief/diaper med |
3,169 |
1,127 |
$66K |
| A4927 |
Non-sterile gloves |
36,562 |
14,710 |
$63K |
| S5199 |
Personal care item nos each |
18,480 |
4,127 |
$63K |
| T4544 |
Adlt disp und/pull on abv xl |
529 |
527 |
$55K |
| T4525 |
Adult size pull-on sm |
1,637 |
667 |
$41K |
| B4154 |
Ef spec metabolic noninherit |
725 |
189 |
$23K |
| S5130 |
Homaker service nos per 15m |
344 |
66 |
$13K |
| B4150 |
Ef complet w/intact nutrient |
1,365 |
74 |
$10K |
| B4152 |
Ef calorie dense>/=1.5kcal |
474 |
25 |
$8K |
| T1019 |
Personal care ser per 15 min |
469 |
67 |
$5K |
| S5135 |
Adult companioncare per 15m |
80 |
20 |
$1K |