| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,403 |
3,397 |
$130K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
873 |
870 |
$120K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,960 |
1,931 |
$85K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
290 |
290 |
$34K |
| A4335 |
Incontinence supply; miscellaneous |
3,508 |
3,503 |
$19K |
| A4927 |
Gloves, non-sterile, per 100 |
548 |
546 |
$4K |
| A6250 |
Skin sealants, protectants, moisturizers, ointments, any type, any size |
619 |
618 |
$3K |