| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 28,390 | $80 | $2.2M |
| 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… | 2,910 | $530 | $1.5M |
| A9276 | Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply | 5,100 | $300 | $1.5M |
| K0553 | Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service | 7,260 | $140 | $1M |
| E0601 | Continuous positive airway pressure (CPAP) device | 14,000 | $60 | $853.8K |
| A9277 | Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system | 1,740 | $420 | $738.2K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 4,660 | $150 | $689.8K |
| E0570 | Nebulizer, with compressor | 12,960 | $50 | $609.1K |
| 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,… | 3,830 | $150 | $567K |
| 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… | 5,430 | $90 | $505.1K |