| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 8 | 20 | 2,040 | $590 | $2.1M |
| E0603 | Breast pump, electric (ac and/or dc), any type | 7 | 30 | 2,290 | $150 | $1.8M |
| 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 | 30 | 3,220 | $390 | $1.5M |
| 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,… | 7 | 40 | 2,610 | $120 | $677.4K |
| A4483 | Moisture exchanger, disposable, for use with invasive mechanical ventilation | 6 | 10 | 1,740 | $210 | $673.8K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 7 | 50 | 4,010 | $80 | $640.4K |
| T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | 9 | 20 | 2,890 | $80 | $601.5K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 15 | 190 | 6,790 | $40 | $579.6K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 7 | 20 | 1,070 | $260 | $575K |
| A4351 | Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each | 8 | 30 | 760 | $100 | $480.6K |