| T2029 | Specialized medical equipment, not otherwise specified, waiver | 1 | 40 | 950 | $130 | $709.9K |
| T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | 15 | 20 | 2,890 | $80 | $601.5K |
| A4351 | Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each | 20 | 30 | 760 | $100 | $480.6K |
| B4154 | Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or… | 13 | 40 | 970 | $120 | $343K |
| T4543 | Adult sized disposable incontinence product, protective brief/diaper, above extra large, each | 6 | 40 | 470 | $180 | $300.4K |
| T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | 4 | 80 | 1,240 | $70 | $295.8K |
| T4541 | Incontinence product, disposable underpad, large, each | 5 | 100 | 2,060 | $30 | $295.1K |
| T4528 | Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each | 4 | 90 | 780 | $80 | $277.8K |
| B4152 | Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include… | 42 | 60 | 900 | $80 | $275.5K |
| T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | 4 | 100 | 810 | $70 | $275.1K |