| 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… | 7 | 20 | 2,380 | $330 | $2.3M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 7 | 30 | 3,000 | $90 | $961.2K |
| 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 | 20 | 2,850 | $110 | $728.4K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 9 | 10 | 1,170 | $160 | $514.8K |
| E0329 | Hospital bed, pediatric, electric or semi-electric, 360 degree side enclosures, top of headboard, footboard and side rails up to 24 inches above the spring, includes mattress | 1 | 10 | 90 | $5,560 | $500.8K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 74 | 150 | 8,400 | $30 | $342.7K |
| E1399 | Durable medical equipment, miscellaneous | 42 | 60 | 150 | $410 | $250.8K |
| T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | 3 | 10 | 1,820 | $60 | $235.8K |
| 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… | 2 | 10 | 800 | $300 | $226.3K |
| T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | 4 | 10 | 1,790 | $60 | $214.4K |