| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
4,084 |
3,851 |
$408K |
| A4554 |
Disposable underpads, all sizes |
4,355 |
4,096 |
$253K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,441 |
1,382 |
$227K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
933 |
870 |
$138K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
951 |
891 |
$128K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
76 |
73 |
$13K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
74 |
72 |
$6K |
| A4259 |
Lancets, per box of 100 |
160 |
125 |
$2K |
| A4244 |
Alcohol or peroxide, per pint |
74 |
72 |
$67.83 |