| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
1,910 |
1,902 |
$60K |
| X1939 |
|
772 |
770 |
$44K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
607 |
606 |
$38K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
430 |
427 |
$21K |
| T5999 |
Supply, not otherwise specified |
3,444 |
3,429 |
$19K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
328 |
327 |
$15K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
269 |
268 |
$7K |