| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,377 |
2,359 |
$128K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,188 |
3,168 |
$87K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,074 |
1,060 |
$86K |
| A4554 |
Disposable underpads, all sizes |
2,467 |
2,454 |
$70K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
883 |
439 |
$48K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
934 |
929 |
$27K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
494 |
247 |
$21K |
| L3221 |
Orthopedic footwear, mens shoe, depth inlay, each |
287 |
144 |
$14K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
331 |
330 |
$10K |
| A4927 |
Gloves, non-sterile, per 100 |
1,501 |
1,486 |
$7K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
38 |
38 |
$2K |