| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
2,591 |
2,565 |
$84K |
| X1939 |
|
1,130 |
1,120 |
$73K |
| T5999 |
Supply, not otherwise specified |
5,390 |
5,305 |
$42K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
659 |
654 |
$34K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
256 |
252 |
$18K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
365 |
361 |
$17K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
522 |
516 |
$15K |
| S5161 |
Emergency response system; service fee, per month (excludes installation and testing) |
320 |
318 |
$10K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
12 |
12 |
$1K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
12 |
12 |
$793.60 |