| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4554 |
Disposable underpads, all sizes |
3,425 |
3,057 |
$117K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
797 |
761 |
$56K |
| X1939 |
|
837 |
831 |
$53K |
| T5999 |
Supply, not otherwise specified |
6,217 |
5,259 |
$50K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
739 |
729 |
$37K |
| X1922 |
|
163 |
125 |
$23K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
484 |
460 |
$22K |
| A4927 |
Gloves, non-sterile, per 100 |
413 |
377 |
$11K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
76 |
59 |
$10K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
346 |
321 |
$10K |
| T4534 |
Youth sized disposable incontinence product, protective underwear/pull-on, each |
86 |
72 |
$8K |
| T4525 |
Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
12 |
12 |
$775.20 |