| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4534 |
Youth size pull-on |
53,411 |
52,396 |
$10.49M |
| T4541 |
Large disposable underpad |
87,493 |
87,288 |
$9.89M |
| T4535 |
Disposable liner/shield/pad |
48,845 |
48,697 |
$4.07M |
| A4335 |
Incontinence supply |
58,091 |
58,037 |
$3.59M |
| T4530 |
Ped size brief/diaper lg |
28,075 |
27,762 |
$2.78M |
| T4537 |
Reusable underpad bed size |
42,789 |
42,755 |
$2.63M |
| T4521 |
Adult size brief/diaper sm |
20,991 |
20,704 |
$2.43M |
| T4522 |
Adult size brief/diaper med |
15,786 |
15,640 |
$2.09M |
| T4526 |
Adult size pull-on med |
14,883 |
14,703 |
$2.04M |
| T4527 |
Adult size pull-on lg |
11,791 |
11,648 |
$1.76M |
| S5199 |
Personal care item nos each |
28,330 |
28,314 |
$1.75M |
| T4523 |
Adult size brief/diaper lg |
9,164 |
9,067 |
$1.29M |
| T4532 |
Ped size pull-on lg |
15,505 |
15,415 |
$1.18M |
| T4525 |
Adult size pull-on sm |
6,466 |
6,385 |
$922K |
| T4528 |
Adult size pull-on xl |
5,075 |
5,013 |
$883K |
| T4540 |
Reusable underpad chair size |
10,163 |
10,161 |
$543K |
| T4524 |
Adult size brief/diaper xl |
3,226 |
3,193 |
$498K |
| T4544 |
Adlt disp und/pull on abv xl |
1,199 |
1,182 |
$315K |
| T4543 |
Adult disp brief/diap abv xl |
585 |
583 |
$148K |
| T4533 |
Youth size brief/diaper |
540 |
526 |
$64K |
| T2028 |
Special supply, nos waiver |
52 |
52 |
$7K |
| T4531 |
Ped size pull-on sm/med |
25 |
25 |
$2K |
| A4927 |
Non-sterile gloves |
51 |
50 |
$879.78 |