| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T4527 |
Adult size pull-on lg |
17 |
17 |
$0.00 |
| A7038 |
Pos airway pressure filter |
13 |
13 |
$0.00 |
| A7035 |
Pos airway press headgear |
13 |
13 |
$0.00 |
| T4530 |
Ped size brief/diaper lg |
12 |
12 |
$0.00 |
| T4522 |
Adult size brief/diaper med |
34 |
34 |
$0.00 |
| T4524 |
Adult size brief/diaper xl |
20 |
20 |
$0.00 |
| T4541 |
Large disposable underpad |
71 |
71 |
$0.00 |
| A7039 |
Filter, non disposable w pap |
12 |
12 |
$0.00 |
| T4526 |
Adult size pull-on med |
16 |
16 |
$0.00 |
| A6250 |
Skin seal protect moisturizr |
22 |
22 |
$0.00 |
| T4542 |
Small disposable underpad |
14 |
14 |
$0.00 |
| T4534 |
Youth size pull-on |
23 |
23 |
$0.00 |
| A4335 |
Incontinence supply |
21 |
21 |
$0.00 |
| B4160 |
Ef ped caloric dense>/=0.7kc |
39 |
23 |
$0.00 |
| T4523 |
Adult size brief/diaper lg |
26 |
26 |
$0.00 |
| T4535 |
Disposable liner/shield/pad |
29 |
29 |
$0.00 |