| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
151 |
150 |
$8K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
54 |
53 |
$6K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
157 |
155 |
$5K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
84 |
84 |
$5K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
25 |
25 |
$678.50 |
| E0240 |
Bath/shower chair, with or without wheels, any size |
12 |
12 |
$464.64 |
| A4927 |
Gloves, non-sterile, per 100 |
29 |
29 |
$133.40 |
| A4335 |
Incontinence supply; miscellaneous |
13 |
13 |
$72.00 |