| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
116 |
116 |
$5K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
45 |
45 |
$4K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
34 |
34 |
$3K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
30 |
30 |
$3K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
15 |
15 |
$2K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
14 |
14 |
$1K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12 |
12 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
74 |
74 |
$1K |
| A4335 |
Incontinence supply; miscellaneous |
56 |
56 |
$391.94 |