| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 21 | 20 | 2,840 | $230 | $1.8M |
| T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | 5 | 40 | 2,280 | $150 | $795.4K |
| T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | 9 | 20 | 2,210 | $170 | $748.4K |
| B4154 | Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or… | 18 | 20 | 1,350 | $240 | $716.5K |
| T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | 3 | 40 | 1,900 | $120 | $627.8K |
| A4554 | Disposable underpads, all sizes | 5 | 60 | 6,090 | $50 | $584.2K |
| T4535 | Disposable liner/shield/guard/pad/undergarment, for incontinence, each | 8 | 50 | 3,480 | $50 | $465.5K |
| B4150 | Enteral formula, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100… | 5 | 40 | 1,190 | $90 | $424.3K |
| T4528 | Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each | 5 | 30 | 1,850 | $120 | $415.4K |
| 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… | 6 | 30 | 1,100 | $120 | $372.6K |