| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
337 |
296 |
$24K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
127 |
112 |
$18K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
74 |
72 |
$12K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
105 |
90 |
$11K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
207 |
181 |
$5K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
173 |
142 |
$2K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
33 |
26 |
$2K |
| A4927 |
Gloves, non-sterile, per 100 |
323 |
277 |
$1K |