| E2402 | Negative pressure wound therapy electrical pump, stationary or portable | 8 | 10 | 60 | $540 | $1.2M |
| B4160 | Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals,… | 5 | 20 | 2,010 | $100 | $586.6K |
| T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | 1 | 20 | 1,990 | $160 | $525.8K |
| B4161 | Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding… | 8 | 20 | 430 | $170 | $500.3K |
| B4154 | Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or… | 10 | 10 | 620 | $110 | $413.3K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 11 | 30 | 2,640 | $50 | $313.6K |
| A6213 | Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | 1 | 10 | 1,170 | $260 | $308.9K |
| B4152 | Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include… | 8 | 20 | 1,610 | $60 | $282.6K |
| T4532 | Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each | 1 | 10 | 1,410 | $170 | $272.5K |
| A6550 | Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories | 5 | 10 | 40 | $80 | $229.4K |