| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
8,561 |
7,655 |
$175K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,396 |
1,338 |
$135K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,456 |
1,416 |
$101K |
| T4541 |
Incontinence product, disposable underpad, large, each |
1,891 |
1,806 |
$88K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
689 |
667 |
$58K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,624 |
1,569 |
$56K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
301 |
289 |
$31K |
| T1999 |
Miscellaneous therapeutic items and supplies, retail purchases, not otherwise classified; identify product in "remarks" |
1,390 |
1,350 |
$16K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
217 |
185 |
$16K |
| S9999 |
Sales tax |
11,839 |
9,060 |
$11K |
| E0570 |
Nebulizer, with compressor |
28 |
27 |
$2K |