| 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… | 5 | 10 | 4,650 | $200 | $3.1M |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 4 | 10 | 2,640 | $480 | $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 | 10 | 2,270 | $70 | $1.6M |
| A4353 | Intermittent urinary catheter, with insertion supplies | 9 | 10 | 220 | $720 | $1.5M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 4 | 10 | 910 | $80 | $1.2M |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 7 | 10 | 1,160 | $430 | $794.5K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 2 | 50 | 3,350 | $50 | $730.5K |
| K0108 | Wheelchair component or accessory, not otherwise specified | 4 | 10 | 1,630 | $170 | $689.1K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 5 | 10 | 4,300 | $80 | $596.9K |
| A4624 | Tracheal suction catheter, any type other than closed system, each | 4 | 10 | 3,910 | $120 | $480.5K |