| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T2028 |
Special supply, nos waiver |
1,482 |
1,434 |
$595K |
| T4523 |
Adult size brief/diaper lg |
321 |
314 |
$120K |
| T4541 |
Large disposable underpad |
1,047 |
1,020 |
$109K |
| T4522 |
Adult size brief/diaper med |
334 |
331 |
$97K |
| Z0645 |
|
343 |
275 |
$80K |
| T4527 |
Adult size pull-on lg |
204 |
203 |
$73K |
| T4528 |
Adult size pull-on xl |
172 |
168 |
$68K |
| T4524 |
Adult size brief/diaper xl |
186 |
180 |
$65K |
| T4526 |
Adult size pull-on med |
199 |
195 |
$64K |
| T4525 |
Adult size pull-on sm |
126 |
122 |
$47K |
| T4544 |
Adlt disp und/pull on abv xl |
57 |
57 |
$34K |
| T4543 |
Adult disp brief/diap abv xl |
47 |
46 |
$29K |
| T4535 |
Disposable liner/shield/pad |
172 |
168 |
$22K |
| T4537 |
Reusable underpad bed size |
179 |
177 |
$9K |
| A9999 |
Dme supply or accessory, nos |
17 |
17 |
$3K |