| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
22,787 |
20,284 |
$747K |
| T5999 |
Supply, not otherwise specified |
45,466 |
36,204 |
$467K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
5,531 |
4,926 |
$376K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
2,927 |
2,623 |
$373K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,292 |
5,448 |
$342K |
| X1939 |
|
5,138 |
5,110 |
$338K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
2,856 |
2,616 |
$320K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
9,334 |
8,382 |
$282K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
2,041 |
1,904 |
$266K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,090 |
2,346 |
$246K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,767 |
4,084 |
$238K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
3,088 |
2,024 |
$231K |
| X1915 |
|
1,596 |
1,509 |
$179K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
1,367 |
1,005 |
$152K |
| A4927 |
Gloves, non-sterile, per 100 |
11,114 |
6,845 |
$118K |
| X1922 |
|
589 |
559 |
$99K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
1,439 |
1,094 |
$82K |
| T4530 |
Pediatric sized disposable incontinence product, brief/diaper, large size, each |
178 |
170 |
$16K |
| T4533 |
Youth sized disposable incontinence product, brief/diaper, each |
26 |
26 |
$4K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
14 |
13 |
$1K |