| 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… | 1 | 10 | 4,330 | $400 | $1.8M |
| E0465 | Home ventilator, any type, used with invasive interface, (e.g., tracheostomy tube) | 1 | 10 | 1,790 | $660 | $1.2M |
| E0202 | Phototherapy (bilirubin) light with photometer | 1 | 10 | 2,490 | $420 | $1.1M |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 1 | 10 | 2,870 | $290 | $821K |
| A4351 | Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, or silicone elastomer, etc.), each | 1 | 10 | 7,700 | $100 | $757.6K |
| E1399 | Durable medical equipment, miscellaneous | 1 | 10 | 580 | $1,170 | $681K |
| 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 | 10 | 420 | $130 | $567.7K |
| A4352 | Intermittent urinary catheter; coude (curved) tip, with or without coating (teflon, silicone, or silicone elastomeric, etc.), each | 1 | 10 | 1,310 | $360 | $476K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 1 | 10 | 2,000 | $130 | $423.1K |
| T4525 | Adult sized disposable incontinence product, protective underwear/pull-on, small size, each | 2 | 10 | 3,960 | $90 | $338K |