| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
270 |
260 |
$28K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
183 |
174 |
$21K |
| A4554 |
Disposable underpads, all sizes |
456 |
451 |
$15K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
50 |
49 |
$6K |
| A4245 |
Alcohol wipes, per box |
687 |
675 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
441 |
431 |
$262.40 |