| A6197 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | 7,030 | $160 | $1.1M |
| A6253 | Specialty absorptive dressing, wound cover, sterile, pad size more than 48 sq. in., without adhesive border, each dressing | 8,360 | $100 | $869K |
| A6212 | Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | 11,060 | $80 | $862.7K |
| A6021 | Collagen dressing, sterile, size 16 sq. in. or less, each | 5,130 | $120 | $589.6K |
| A6196 | Alginate or other fiber gelling dressing, wound cover, sterile, pad size 16 sq. in. or less, each dressing | 7,650 | $70 | $512.5K |
| A6252 | Specialty absorptive dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | 9,690 | $50 | $455.3K |
| A6210 | Foam dressing, wound cover, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing | 2,090 | $170 | $363.8K |
| A6446 | Conforming bandage, non-elastic, knitted/woven, sterile, width greater than or equal to three inches and less than five inches, per yard | 20,700 | $20 | $351.8K |
| 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,… | 1,740 | $180 | $317.7K |
| A4216 | Sterile water, saline and/or dextrose, diluent/flush, 10 ml | 18,370 | $10 | $257.2K |