| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
454 |
424 |
$14K |
| X1939 |
|
224 |
224 |
$14K |
| T5999 |
Supply, not otherwise specified |
911 |
841 |
$7K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
145 |
145 |
$6K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
191 |
191 |
$5K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
38 |
38 |
$2K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12 |
12 |
$748.80 |