| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,049 |
2,942 |
$98K |
| T5999 |
Supply, not otherwise specified |
5,759 |
5,179 |
$58K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
671 |
624 |
$39K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,051 |
1,040 |
$31K |
| X1939 |
|
500 |
498 |
$27K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
139 |
128 |
$9K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
103 |
101 |
$6K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
16 |
14 |
$1K |
| A4927 |
Gloves, non-sterile, per 100 |
80 |
49 |
$937.64 |