| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,893 |
3,621 |
$153K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
560 |
523 |
$76K |
| A4927 |
Gloves, non-sterile, per 100 |
3,624 |
3,394 |
$73K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,440 |
1,355 |
$72K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
246 |
222 |
$33K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
127 |
117 |
$13K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
66 |
65 |
$11K |
| A4553 |
Non-disposable underpads, all sizes |
370 |
357 |
$5K |
| A6197 |
Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing |
23 |
22 |
$1K |