| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
853 |
848 |
$30K |
| T5999 |
Supply, not otherwise specified |
2,215 |
2,195 |
$13K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
146 |
146 |
$10K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
126 |
125 |
$7K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
160 |
158 |
$5K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
13 |
13 |
$1K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
13 |
13 |
$617.50 |