| Code | Description | Claims | Beneficiaries | Total Paid |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
367 |
355 |
$33K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
245 |
239 |
$19K |
| A4554 |
Disposable underpads, all sizes |
208 |
201 |
$9K |
| E0570 |
Nebulizer, with compressor |
45 |
44 |
$3K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
12 |
12 |
$478.94 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
24 |
24 |
$112.21 |