| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,313 |
3,159 |
$104K |
| X1939 |
|
1,408 |
1,371 |
$84K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
942 |
903 |
$49K |
| T5999 |
Supply, not otherwise specified |
5,722 |
5,068 |
$33K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
280 |
255 |
$18K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
81 |
80 |
$4K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
80 |
74 |
$4K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
12 |
12 |
$1K |
| E0570 |
Nebulizer, with compressor |
33 |
26 |
$774.45 |
| A4927 |
Gloves, non-sterile, per 100 |
48 |
38 |
$358.07 |