| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| X1915 |
|
752 |
742 |
$57K |
| T5999 |
Supply, not otherwise specified |
2,274 |
1,685 |
$22K |
| A4554 |
Disposable underpads, all sizes |
652 |
589 |
$21K |
| T4527 |
Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
367 |
298 |
$19K |
| T2028 |
Specialized supply, not otherwise specified, waiver |
214 |
203 |
$15K |
| T4526 |
Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
177 |
157 |
$9K |
| A4927 |
Gloves, non-sterile, per 100 |
1,008 |
748 |
$6K |
| T4535 |
Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
40 |
37 |
$1K |
| T4528 |
Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
14 |
12 |
$998.40 |