| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
627 |
404 |
$42K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
202 |
155 |
$31K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
208 |
167 |
$25K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
149 |
114 |
$13K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
271 |
217 |
$11K |
| T4541 |
Incontinence product, disposable underpad, large, each |
59 |
46 |
$2K |
| L0621 |
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf |
30 |
14 |
$1K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
75 |
50 |
$1K |
| A4520 |
Incontinence garment, any type, (e.g., brief, diaper), each |
156 |
149 |
$0.00 |
| A4553 |
Non-disposable underpads, all sizes |
12 |
12 |
$0.00 |