| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
1,774 |
1,470 |
$122K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
616 |
536 |
$88K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
548 |
497 |
$63K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
355 |
327 |
$58K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
991 |
802 |
$26K |
| A4927 |
Gloves, non-sterile, per 100 |
1,661 |
1,357 |
$6K |