| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
14,666 |
13,490 |
$495K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,581 |
2,477 |
$306K |
| T5999 |
Supply, not otherwise specified |
27,063 |
21,805 |
$284K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,535 |
3,064 |
$238K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,247 |
3,784 |
$225K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,681 |
3,017 |
$183K |
| X1939 |
|
2,994 |
2,983 |
$181K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,810 |
1,431 |
$160K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,137 |
925 |
$156K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,921 |
1,512 |
$144K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,650 |
1,416 |
$118K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,753 |
3,393 |
$116K |
| X1915 |
|
707 |
679 |
$101K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
772 |
662 |
$93K |
| A4927 |
Gloves, non-sterile, per 100 |
3,542 |
2,278 |
$39K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
76 |
75 |
$11K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
67 |
57 |
$10K |
| E0602 |
Breast pump, manual, any type |
185 |
184 |
$7K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
24 |
24 |
$3K |
| E0570 |
Nebulizer, with compressor |
30 |
28 |
$1K |