| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
2,408 |
2,272 |
$79K |
| X1939 |
|
759 |
647 |
$46K |
| T5999 |
Supply, not otherwise specified |
4,984 |
4,753 |
$34K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
484 |
448 |
$32K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
860 |
793 |
$25K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
384 |
363 |
$19K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
156 |
137 |
$8K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
22 |
22 |
$3K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
27 |
27 |
$3K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
26 |
14 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
13 |
13 |
$921.60 |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
21 |
14 |
$660.87 |