| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 14 | 20 | 2,410 | $130 | $1.1M |
| 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 | 1,260 | $130 | $442.9K |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 4 | 140 | 5,290 | $40 | $300.2K |
| B9002 | Enteral nutrition infusion pump, any type | 19 | 20 | 1,440 | $80 | $239.4K |
| B4088 | Gastrostomy/jejunostomy tube, low-profile, any material, any type, each | 12 | 20 | 400 | $90 | $137.2K |
| B4152 | Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include… | 13 | 20 | 760 | $80 | $136.1K |
| E0431 | Portable gaseous oxygen system, rental; includes portable container, regulator, flowmeter, humidifier, cannula or mask, and tubing | 3 | 120 | 2,500 | $30 | $117.2K |
| K0823 | Power wheelchair, group 2 standard, captains chair, patient weight capacity up to and including 300 pounds | 10 | 10 | 530 | $130 | $101.9K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 12 | 20 | 650 | $50 | $92.5K |
| K0738 | Portable gaseous oxygen system, rental; home compressor used to fill portable oxygen cylinders; includes portable containers, regulator, flowmeter, humidifier, cannula or mask, and tubing | 3 | 50 | 1,230 | $30 | $76.9K |