| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
21,054 |
20,151 |
$673K |
| X1939 |
|
8,504 |
8,476 |
$519K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
6,299 |
5,941 |
$417K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
6,263 |
6,005 |
$321K |
| T5999 |
Supply, not otherwise specified |
33,769 |
31,141 |
$232K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
3,034 |
2,058 |
$220K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
4,725 |
4,449 |
$213K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
2,001 |
1,609 |
$186K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,222 |
1,206 |
$157K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
4,281 |
4,237 |
$121K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,296 |
955 |
$77K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
682 |
634 |
$58K |
| A4927 |
Gloves, non-sterile, per 100 |
4,682 |
3,447 |
$50K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
750 |
673 |
$39K |
| X1915 |
|
308 |
287 |
$24K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
14 |
12 |
$1K |
| T4521 |
Adult sized disposable incontinence product, brief/diaper, small, each |
15 |
15 |
$1K |