| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
31 |
31 |
$3K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
35 |
34 |
$3K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
25 |
25 |
$3K |
| A4927 |
Gloves, non-sterile, per 100 |
171 |
170 |
$2K |
| T4541 |
Incontinence product, disposable underpad, large, each |
33 |
33 |
$2K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
19 |
19 |
$478.53 |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
16 |
16 |
$469.59 |