| 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… | 8 | 10 | 2,190 | $710 | $6.2M |
| 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,… | 6 | 10 | 3,250 | $210 | $2.5M |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 3 | 10 | 2,200 | $760 | $2.1M |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 7 | 20 | 2,850 | $160 | $1.5M |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 3 | 10 | 520 | $310 | $1.5M |
| E1399 | Durable medical equipment, miscellaneous | 3 | 20 | 660 | $450 | $1.2M |
| 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… | 4 | 10 | 660 | $460 | $1.2M |
| E1390 | Oxygen concentrator, single delivery port, capable of delivering 85 percent or greater oxygen concentration at the prescribed flow rate | 2 | 100 | 8,410 | $40 | $728.2K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 10 | 20 | 2,730 | $90 | $643.1K |
| 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 | 2 | 10 | 1,500 | $390 | $584.3K |