| 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… | 4,720 | $750 | $3.5M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 16,940 | $160 | $2.7M |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 5,790 | $370 | $2.1M |
| 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,… | 3,940 | $240 | $941.4K |
| B4088 | Gastrostomy/jejunostomy tube, low-profile, any material, any type, each | 4,980 | $160 | $811.7K |
| A4223 | Infusion supplies not used with external infusion pump, per cassette or bag (list drugs separately) | 27,830 | $20 | $556.7K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 5,860 | $70 | $427.6K |
| B4162 | Enteral formula, for pediatrics, special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an… | 470 | $500 | $235.1K |
| A4222 | Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) | 3,460 | $70 | $228.1K |
| A4221 | Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) | 8,510 | $20 | $204.1K |