| 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… | 14 | 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,… | 11 | 40 | 2,610 | $120 | $677.4K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 16 | 50 | 4,010 | $80 | $640.4K |
| T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | 10 | 20 | 2,890 | $80 | $601.5K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 10 | 20 | 1,070 | $260 | $575K |
| A4351 | Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each | 18 | 30 | 760 | $100 | $480.6K |
| T4544 | Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each | 5 | 20 | 420 | $120 | $378.3K |
| 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… | 12 | 20 | 870 | $290 | $368.4K |
| B9998 | Noc for enteral supplies | 8 | 30 | 1,440 | $50 | $368.1K |
| B4154 | Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or… | 7 | 40 | 970 | $120 | $343K |