| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
2,806 |
2,806 |
$266K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,709 |
4,700 |
$159K |
| A4554 |
Disposable underpads, all sizes |
3,177 |
3,175 |
$155K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,311 |
2,309 |
$132K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
3,967 |
3,961 |
$128K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,845 |
1,844 |
$54K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
775 |
388 |
$36K |
| A4927 |
Gloves, non-sterile, per 100 |
921 |
921 |
$4K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
72 |
36 |
$3K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
28 |
14 |
$1K |