| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
14,614 |
12,634 |
$491K |
| T5999 |
Supply, not otherwise specified |
32,192 |
23,131 |
$401K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,142 |
4,608 |
$326K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
4,584 |
3,666 |
$316K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,991 |
1,660 |
$272K |
| X1939 |
|
3,851 |
3,838 |
$254K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,401 |
3,478 |
$220K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
2,173 |
1,786 |
$188K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
2,880 |
1,914 |
$188K |
| A4927 |
Gloves, non-sterile, per 100 |
15,778 |
8,865 |
$162K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,350 |
4,137 |
$125K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
1,497 |
968 |
$113K |
| X1915 |
|
762 |
749 |
$61K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
423 |
316 |
$56K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
426 |
394 |
$49K |