| Code | Description | Claims | Beneficiaries | Total Paid |
| A4554 |
Disposable underpads, all sizes |
2,934 |
2,927 |
$116K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,052 |
1,052 |
$90K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
520 |
519 |
$50K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
529 |
529 |
$32K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
780 |
780 |
$28K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
27 |
27 |
$1K |
| A4402 |
Lubricant, per ounce |
143 |
143 |
$973.61 |