| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,845 |
1,504 |
$493K |
| A6154 |
Wound pouch, each |
1,241 |
913 |
$416K |
| 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 |
2,035 |
1,596 |
$181K |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,098 |
1,708 |
$134K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,573 |
1,292 |
$64K |
| A6211 |
Foam dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing |
168 |
126 |
$48K |
| A4927 |
Gloves, non-sterile, per 100 |
1,747 |
1,394 |
$24K |
| A6535 |
Gradient compression stocking, thigh length, 40 mmhg or greater, each |
12 |
12 |
$2K |