| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
1,955 |
1,943 |
$64K |
| T5999 |
Supply, not otherwise specified |
3,281 |
3,269 |
$19K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
98 |
98 |
$5K |
| X1939 |
|
60 |
60 |
$4K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
40 |
38 |
$3K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
24 |
24 |
$1K |