| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
4,474 |
4,450 |
$142K |
| X1939 |
|
1,870 |
1,860 |
$115K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,142 |
1,136 |
$73K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
1,248 |
1,246 |
$62K |
| T5999 |
Supply, not otherwise specified |
6,480 |
6,451 |
$33K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
724 |
721 |
$33K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
126 |
126 |
$4K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
37 |
37 |
$3K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
14 |
14 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
15 |
15 |
$972.80 |