| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
409 |
330 |
$40K |
| A6530 |
Gradient compression stocking, below knee, 18-30 mmhg, each |
540 |
498 |
$32K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
330 |
287 |
$26K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
117 |
105 |
$11K |
| T4541 |
Incontinence product, disposable underpad, large, each |
317 |
252 |
$6K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
108 |
90 |
$4K |
| A4927 |
Gloves, non-sterile, per 100 |
123 |
87 |
$3K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
356 |
318 |
$0.00 |
| T2028 |
Specialized supply, not otherwise specified, waiver |
107 |
59 |
$0.00 |
| A9270 |
Non-covered item or service |
17 |
12 |
$0.00 |