| Code | Description | Claims | Beneficiaries | Total Paid |
| A4554 |
Disposable underpads, all sizes |
3,236 |
3,184 |
$115K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
436 |
433 |
$45K |
| A4335 |
Incontinence supply; miscellaneous |
4,143 |
4,059 |
$21K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
456 |
423 |
$14K |
| T4532 |
Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
24 |
24 |
$3K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
24 |
24 |
$2K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
12 |
12 |
$1K |