| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
9,402 |
9,398 |
$330K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
5,519 |
5,517 |
$262K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,635 |
2,632 |
$187K |
| A4554 |
Disposable underpads, all sizes |
3,977 |
3,977 |
$130K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,288 |
1,286 |
$32K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
1,188 |
1,188 |
$26K |
| A4927 |
Gloves, non-sterile, per 100 |
4,861 |
4,844 |
$22K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
186 |
186 |
$9K |
| A4335 |
Incontinence supply; miscellaneous |
1,407 |
1,404 |
$7K |
| A4402 |
Lubricant, per ounce |
171 |
171 |
$3K |
| E0570 |
Nebulizer, with compressor |
24 |
24 |
$2K |
| A4670 |
Automatic blood pressure monitor |
12 |
12 |
$600.00 |
| E1399 |
Durable medical equipment, miscellaneous |
79 |
79 |
$506.70 |
| A4259 |
Lancets, per box of 100 |
24 |
24 |
$170.28 |