| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
1,021 |
1,020 |
$85K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
227 |
227 |
$41K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,014 |
1,008 |
$41K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
226 |
226 |
$38K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
249 |
249 |
$31K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
877 |
867 |
$29K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
232 |
231 |
$27K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
998 |
998 |
$22K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
80 |
80 |
$8K |
| A4927 |
Gloves, non-sterile, per 100 |
1,012 |
1,008 |
$5K |