| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4353 |
Intermittent urinary catheter, with insertion supplies |
2,266 |
1,864 |
$2.41M |
| T4541 |
Incontinence product, disposable underpad, large, each |
2,768 |
2,304 |
$187K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
725 |
646 |
$105K |
| A4927 |
Gloves, non-sterile, per 100 |
1,581 |
1,330 |
$23K |
| A4358 |
Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each |
1,112 |
949 |
$13K |
| A4349 |
Male external catheter, with or without adhesive, disposable, each |
166 |
135 |
$7K |
| A4670 |
Automatic blood pressure monitor |
30 |
18 |
$2K |
| A6402 |
Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing |
12 |
12 |
$250.80 |