| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
2,687 |
2,687 |
$231K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
2,497 |
2,497 |
$90K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
2,496 |
2,496 |
$48K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
462 |
462 |
$48K |
| L8030 |
Breast prosthesis, silicone or equal, without integral adhesive |
79 |
67 |
$18K |
| A4927 |
Gloves, non-sterile, per 100 |
2,449 |
2,449 |
$10K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
49 |
49 |
$5K |
| L8000 |
Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type |
90 |
85 |
$5K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
109 |
109 |
$4K |