| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| X1939 |
|
3,749 |
3,742 |
$234K |
| A4554 |
Disposable underpads, all sizes |
4,444 |
4,404 |
$161K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,108 |
1,100 |
$76K |
| T5999 |
Supply, not otherwise specified |
7,989 |
7,932 |
$71K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,020 |
1,010 |
$51K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
923 |
921 |
$30K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
456 |
452 |
$28K |
| A4927 |
Gloves, non-sterile, per 100 |
457 |
451 |
$6K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
29 |
29 |
$2K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
12 |
12 |
$1K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
12 |
12 |
$1K |