| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,873 |
1,804 |
$275K |
| A4554 |
Disposable underpads, all sizes |
4,076 |
3,815 |
$240K |
| A4927 |
Gloves, non-sterile, per 100 |
5,234 |
5,031 |
$229K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,181 |
1,108 |
$157K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
478 |
463 |
$70K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
26 |
26 |
$4K |
| T5999 |
Supply, not otherwise specified |
306 |
220 |
$4K |
| A4335 |
Incontinence supply; miscellaneous |
155 |
146 |
$700.04 |