| 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… | 11 | 30 | 1,790 | $670 | $1.8M |
| E1399 | Durable medical equipment, miscellaneous | 6 | 50 | 420 | $790 | $880.5K |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 15 | 30 | 1,450 | $520 | $775K |
| T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | 58 | 60 | 2,140 | $60 | $601K |
| 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,… | 26 | 50 | 1,820 | $180 | $550K |
| 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… | 18 | 20 | 400 | $690 | $542.2K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 9 | 60 | 2,250 | $110 | $520.7K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 14 | 20 | 550 | $350 | $501.6K |
| A6258 | Transparent film, sterile, more than 16 sq. in. but less than or equal to 48 sq. in., each dressing | 7 | 10 | 110 | $140 | $452.4K |
| A4554 | Disposable underpads, all sizes | 41 | 80 | 3,420 | $30 | $414K |