| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,077 |
1,037 |
$51K |
| S5199 |
Personal care item, nos, each |
2,126 |
2,074 |
$47K |
| A4554 |
Disposable underpads, all sizes |
2,138 |
2,052 |
$40K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
485 |
468 |
$36K |
| A4927 |
Gloves, non-sterile, per 100 |
1,824 |
1,742 |
$35K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
560 |
535 |
$20K |
| A4245 |
Alcohol wipes, per box |
704 |
661 |
$14K |