| 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… | 4 | 10 | 250 | $930 | $905.7K |
| B4035 | Enteral feeding supply kit; pump fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 4 | 10 | 3,440 | $180 | $673K |
| 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,… | 3 | 10 | 820 | $360 | $604.5K |
| B4149 | Enteral formula, manufactured blenderized natural foods with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral… | 2 | 10 | 850 | $310 | $571.8K |
| T4541 | Incontinence product, disposable underpad, large, each | 12 | 30 | 1,460 | $30 | $266K |
| T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each | 17 | 30 | 920 | $70 | $238.7K |
| T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each | 15 | 30 | 990 | $70 | $238.1K |
| A9276 | Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply | 2 | 10 | 380 | $550 | $209K |
| B4034 | Enteral feeding supply kit; syringe fed, per day, includes but not limited to feeding/flushing syringe, administration set tubing, dressings, tape | 4 | 10 | 1,630 | $100 | $183.7K |
| T4528 | Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each | 19 | 30 | 340 | $90 | $175.7K |