| 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… | 8 | 10 | 1,430 | $720 | $3.4M |
| 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,… | 10 | 20 | 2,100 | $310 | $2.6M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 8 | 20 | 2,840 | $230 | $1.8M |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 4 | 10 | 1,400 | $340 | $1.4M |
| B4088 | Gastrostomy/jejunostomy tube, low-profile, any material, any type, each | 4 | 10 | 2,420 | $140 | $1.3M |
| 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… | 6 | 10 | 670 | $450 | $1.1M |
| B9998 | Noc for enteral supplies | 5 | 10 | 4,710 | $80 | $1M |
| B4155 | Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium… | 10 | 20 | 840 | $310 | $871K |
| T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | 18 | 40 | 2,280 | $150 | $795.4K |
| T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each | 8 | 20 | 2,210 | $170 | $748.4K |