| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,161 |
1,160 |
$156K |
| A4927 |
Gloves, non-sterile, per 100 |
4,058 |
4,055 |
$68K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
432 |
425 |
$50K |
| T4542 |
Incontinence product, disposable underpad, small size, each |
655 |
653 |
$28K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
748 |
667 |
$2K |
| A4259 |
Lancets, per box of 100 |
14 |
14 |
$3.65 |