| A6210 | Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | 6 | 10 | 2,090 | $420 | $1.1M |
| 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,… | 11 | 30 | 490 | $190 | $874.5K |
| T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | 7 | 30 | 1,460 | $130 | $845.1K |
| B9998 | Noc for enteral supplies | 5 | 20 | 640 | $220 | $845K |
| B4153 | Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 9 | 10 | 1,120 | $330 | $484.5K |
| T4543 | Adult sized disposable incontinence product, protective brief/diaper, above extra large, each | 5 | 40 | 1,130 | $240 | $472.4K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 10 | 40 | 1,050 | $130 | $467.9K |
| T4532 | Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each | 10 | 10 | 250 | $100 | $457.1K |
| T4523 | Adult sized disposable incontinence product, brief/diaper, large, each | 3 | 40 | 690 | $100 | $422.2K |
| T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | 11 | 80 | 950 | $90 | $411.3K |