| L4361 | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf | 1 | 10 | 1,720 | $230 | $399.9K |
| A6253 | Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | 1 | 10 | 1,400 | $200 | $273.1K |
| A6197 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | 1 | 10 | 1,090 | $210 | $227.9K |
| L1833 | Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf | 1 | 10 | 330 | $470 | $151.3K |
| L3660 | Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf | 1 | 10 | 1,410 | $60 | $90.2K |
| E0143 | Walker, folding, wheeled, adjustable or fixed height | 1 | 10 | 460 | $60 | $82.5K |
| L1820 | Knee orthosis, elastic with condylar pads and joints, with or without patellar control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific… | 1 | 10 | 760 | $110 | $81.9K |
| E1399 | Durable medical equipment, miscellaneous | 7 | 10 | 50 | $40 | $70K |
| A6212 | Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | 1 | 10 | 50 | $70 | $66.8K |
| L3908 | Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf | 1 | 10 | 10 | $60 | $61.6K |