| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
112 |
112 |
$4K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
19 |
19 |
$3K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
59 |
59 |
$2K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
13 |
13 |
$1K |
| A4335 |
Incontinence supply; miscellaneous |
115 |
115 |
$648.66 |
| A4927 |
Gloves, non-sterile, per 100 |
34 |
34 |
$264.52 |