| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
943 |
912 |
$85K |
| A4554 |
Disposable underpads, all sizes |
741 |
712 |
$42K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
200 |
194 |
$17K |
| B4100 |
Food thickener, administered orally, per ounce |
347 |
322 |
$12K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
2,399 |
2,357 |
$6K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
60 |
55 |
$5K |
| A4927 |
Gloves, non-sterile, per 100 |
454 |
433 |
$2K |
| A4259 |
Lancets, per box of 100 |
1,159 |
1,131 |
$2K |
| 0011A |
|
16 |
16 |
$211.68 |
| 91301 |
|
14 |
14 |
$0.00 |