| 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… | 2,540 | $680 | $1.7M |
| B4157 | Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber,… | 1,910 | $670 | $1.3M |
| T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | 10,660 | $120 | $1.3M |
| S9435 | Medical foods for inborn errors of metabolism | 2,320 | $470 | $1.1M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 3,840 | $250 | $954.9K |
| 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,… | 4,820 | $190 | $935.3K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 2,000 | $370 | $739.3K |
| 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… | 750 | $730 | $543.8K |
| B9002 | Enteral nutrition infusion pump, any type | 4,770 | $90 | $428.9K |
| B4100 | Food thickener, administered orally, per ounce | 2,250 | $160 | $352.8K |