| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2028 |
Specialized supply, not otherwise specified, waiver |
1,916 |
1,770 |
$377K |
| A4554 |
Disposable underpads, all sizes |
9,672 |
7,934 |
$334K |
| T5999 |
Supply, not otherwise specified |
16,284 |
12,259 |
$184K |
| T4543 |
Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
1,359 |
1,114 |
$179K |
| X1939 |
|
1,903 |
1,894 |
$126K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
2,137 |
1,874 |
$113K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
1,615 |
1,396 |
$110K |
| A4927 |
Gloves, non-sterile, per 100 |
5,856 |
3,518 |
$82K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
2,716 |
2,509 |
$82K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
1,204 |
929 |
$62K |
| T4523 |
Adult sized disposable incontinence product, brief/diaper, large, each |
549 |
428 |
$36K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
196 |
178 |
$26K |
| X1922 |
|
84 |
81 |
$22K |
| T4524 |
Adult sized disposable incontinence product, brief/diaper, extra large, each |
21 |
18 |
$2K |
| T4522 |
Adult sized disposable incontinence product, brief/diaper, medium, each |
22 |
16 |
$1K |