| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
5,101 |
4,848 |
$162K |
| X1939 |
|
2,292 |
2,233 |
$142K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,775 |
1,683 |
$116K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,115 |
2,000 |
$107K |
| T5999 |
Supply, not otherwise specified |
10,322 |
9,498 |
$73K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,223 |
1,111 |
$63K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
1,783 |
1,712 |
$51K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
170 |
161 |
$21K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
311 |
295 |
$18K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
158 |
156 |
$18K |
| X1915 |
|
134 |
117 |
$11K |
| A4927 |
Gloves, non-sterile, per 100 |
1,381 |
968 |
$10K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
105 |
86 |
$5K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
46 |
46 |
$5K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
94 |
65 |
$4K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
62 |
62 |
$4K |