| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
959 |
918 |
$91K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
497 |
467 |
$78K |
| A4245 |
Alcohol wipes, per box |
1,153 |
1,086 |
$41K |
| A4927 |
Gloves, non-sterile, per 100 |
1,291 |
1,238 |
$32K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
122 |
121 |
$24K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
69 |
67 |
$8K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
163 |
149 |
$182.49 |