| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 2 | 10 | 3,700 | $630 | $4.3M |
| 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… | 13 | 20 | 1,330 | $590 | $1.8M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 14 | 30 | 2,590 | $110 | $1.4M |
| A4605 | Tracheal suction catheter, closed system, each | 2 | 10 | 1,390 | $360 | $1.2M |
| 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,… | 15 | 20 | 2,110 | $220 | $915.7K |
| A7507 | Filter holder and integrated filter without adhesive, for use in a tracheostoma heat and moisture exchange system, each | 3 | 10 | 2,630 | $150 | $832.8K |
| A4624 | Tracheal suction catheter, any type other than closed system, each | 3 | 10 | 780 | $270 | $823.3K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 12 | 10 | 760 | $290 | $783K |
| A9900 | Miscellaneous dme supply, accessory, and/or service component of another hcpcs code | 2 | 10 | 1,000 | $330 | $766.8K |
| E0466 | Home ventilator, any type, used with non-invasive interface, (e.g., mask, chest shell) | 12 | 40 | 860 | $450 | $660.3K |