| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,108 |
990 |
$111K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,559 |
1,514 |
$84K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,006 |
942 |
$81K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
993 |
935 |
$69K |
| A4554 |
Disposable underpads, all sizes |
1,567 |
1,512 |
$48K |
| A4927 |
Gloves, non-sterile, per 100 |
956 |
942 |
$8K |
| T4544 |
Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
24 |
24 |
$3K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
28 |
24 |
$2K |
| E0570 |
Nebulizer, with compressor |
527 |
423 |
$2K |
| L3908 |
Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf |
41 |
30 |
$2K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
556 |
554 |
$126.48 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
29 |
29 |
$13.20 |