| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
1,497 |
1,438 |
$22K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
175 |
175 |
$18K |
| A4927 |
Gloves, non-sterile, per 100 |
1,124 |
1,090 |
$13K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
41 |
39 |
$4K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
27 |
26 |
$3K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
14 |
13 |
$1K |