| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
2,820 |
2,449 |
$78K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,029 |
962 |
$58K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
402 |
368 |
$41K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
195 |
184 |
$22K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
134 |
125 |
$14K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
60 |
53 |
$6K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
30 |
30 |
$2K |
| A4553 |
Non-disposable underpads, all sizes |
82 |
64 |
$763.42 |