| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| X1939 |
|
864 |
862 |
$56K |
| A4554 |
Disposable underpads, all sizes |
1,336 |
1,334 |
$42K |
| T5999 |
Supply, not otherwise specified |
2,631 |
2,628 |
$13K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
88 |
88 |
$4K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
49 |
49 |
$3K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12 |
12 |
$873.60 |