| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
523 |
523 |
$16K |
| X1939 |
|
156 |
156 |
$11K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
144 |
142 |
$9K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
127 |
127 |
$6K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
121 |
121 |
$5K |
| T5999 |
Supply, not otherwise specified |
867 |
819 |
$5K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
119 |
115 |
$3K |
| A4927 |
Gloves, non-sterile, per 100 |
128 |
98 |
$1K |