| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,831 |
1,610 |
$240K |
| A4927 |
Gloves, non-sterile, per 100 |
717 |
640 |
$42K |
| A4554 |
Disposable underpads, all sizes |
822 |
728 |
$41K |
| A5120 |
Skin barrier, wipes or swabs, each |
367 |
323 |
$3K |
| A4245 |
Alcohol wipes, per box |
328 |
312 |
$2K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
24 |
24 |
$2K |
| A4259 |
Lancets, per box of 100 |
1,471 |
1,293 |
$1K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,208 |
1,147 |
$424.55 |
| 0011A |
|
58 |
58 |
$0.00 |
| 0134A |
|
23 |
23 |
$0.00 |
| 0064A |
|
125 |
125 |
$0.00 |
| 0012A |
|
53 |
53 |
$0.00 |