| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,142 |
2,000 |
$595K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,086 |
1,951 |
$136K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,975 |
1,844 |
$93K |
| A6229 |
Gauze, impregnated, water or normal saline, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing |
735 |
720 |
$69K |
| A4927 |
Gloves, non-sterile, per 100 |
1,964 |
1,812 |
$28K |
| A6154 |
Wound pouch, each |
78 |
78 |
$27K |
| A6535 |
Gradient compression stocking, thigh length, 40 mmhg or greater, each |
26 |
26 |
$4K |