| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
1,017 |
1,017 |
$34K |
| X1939 |
|
402 |
398 |
$28K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
656 |
656 |
$20K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
232 |
232 |
$12K |
| T5999 |
Supply, not otherwise specified |
1,384 |
1,384 |
$7K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
83 |
83 |
$6K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
56 |
55 |
$3K |