| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4541 |
Incontinence product, disposable underpad, large, each |
1,586 |
1,585 |
$91K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,622 |
1,439 |
$89K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
164 |
164 |
$9K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
24 |
24 |
$2K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
18 |
16 |
$720.00 |