| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| X1939 |
|
2,581 |
2,567 |
$167K |
| A4554 |
Disposable underpads, all sizes |
4,664 |
4,021 |
$153K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,712 |
1,576 |
$115K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,339 |
1,242 |
$77K |
| T5999 |
Supply, not otherwise specified |
9,242 |
7,925 |
$70K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
803 |
779 |
$24K |
| A4927 |
Gloves, non-sterile, per 100 |
1,540 |
920 |
$16K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
106 |
92 |
$14K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
73 |
49 |
$9K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
123 |
112 |
$8K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
73 |
57 |
$6K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
73 |
69 |
$4K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
54 |
37 |
$4K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
28 |
26 |
$3K |
| X1915 |
|
12 |
12 |
$1K |
| E1390 |
Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate |
14 |
12 |
$892.98 |