| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,722 |
1,654 |
$206K |
| A4554 |
Disposable underpads, all sizes |
2,315 |
2,222 |
$132K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
717 |
684 |
$66K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
406 |
394 |
$53K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
151 |
147 |
$5K |
| A4259 |
Lancets, per box of 100 |
286 |
281 |
$3K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
13 |
12 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
316 |
297 |
$696.63 |
| A4245 |
Alcohol wipes, per box |
26 |
26 |
$54.62 |