| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
4,431 |
4,420 |
$198K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,923 |
1,910 |
$180K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,360 |
4,341 |
$150K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
907 |
907 |
$83K |
| T4539 |
Incontinence product, diaper/brief, reusable, any size, each |
2,435 |
2,416 |
$73K |
| L3030 |
Foot, insert, removable, formed to patient foot, each |
656 |
480 |
$42K |
| T4537 |
Incontinence product, protective underpad, reusable, bed size, each |
1,131 |
1,129 |
$35K |
| L3216 |
Orthopedic footwear, ladies shoe, depth inlay, each |
347 |
223 |
$18K |
| A4927 |
Gloves, non-sterile, per 100 |
2,656 |
2,650 |
$12K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
64 |
64 |
$4K |
| T4540 |
Incontinence product, protective underpad, reusable, chair size, each |
206 |
206 |
$3K |