| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4927 |
Gloves, non-sterile, per 100 |
686 |
552 |
$28K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
384 |
314 |
$28K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
452 |
365 |
$22K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
312 |
269 |
$22K |
| A4554 |
Disposable underpads, all sizes |
468 |
381 |
$16K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
198 |
160 |
$12K |