| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
1,838 |
1,795 |
$57K |
| A4456 |
Adhesive remover, wipes, any type, each |
411 |
408 |
$33K |
| B4035 |
Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape |
52 |
49 |
$27K |
| T4541 |
Incontinence product, disposable underpad, large, each |
413 |
392 |
$26K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
116 |
116 |
$17K |
| A4245 |
Alcohol wipes, per box |
415 |
399 |
$10K |