| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| X1939 |
|
6,214 |
6,107 |
$402K |
| A4554 |
Disposable underpads, all sizes |
11,826 |
11,629 |
$401K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
3,609 |
3,560 |
$250K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
4,073 |
4,044 |
$221K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
3,330 |
3,294 |
$167K |
| T5999 |
Supply, not otherwise specified |
20,754 |
20,512 |
$160K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
836 |
832 |
$110K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
3,164 |
3,115 |
$94K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
1,074 |
1,048 |
$72K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
346 |
344 |
$35K |
| A4927 |
Gloves, non-sterile, per 100 |
2,061 |
1,945 |
$21K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
135 |
133 |
$11K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
79 |
74 |
$7K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
54 |
53 |
$3K |