Each night, host David Letterman would present a list of ten items, compiled by his writing staff, that circulated around a common theme.

[1][2] According to O'Donnell, the Top Ten List was an "almost simultaneous inspiration arriving from staffers Jim Downey, Randy Cohen and Robert "Morty" Morton — largely prompted by the ridiculous 'eligible bachelor' lists in a local New York paper that included the 84-year-old Bill Paley.

The only significant modifications in the Late Show years were the elimination of mentioning a "home office" (such as Wahoo, Nebraska),[citation needed] and the addition of a computer-animated introduction and closing as well as background graphics.

The entries are read by Letterman in reverse countdown order, and are accompanied by a drum roll performed by CBS Orchestra drummer Anton Fig.

At times, the list has also been given by a series of presenters, with each providing one entry; for example, the list for "Ten Things I've Always Wanted to Say to Dave", was used for Letterman's final show in 2015 and included entries from Alec Baldwin, Barbara Walters, Steve Martin, Jerry Seinfeld, Jim Carrey, Chris Rock, Julia Louis-Dreyfus, Peyton Manning, Tina Fey and Bill Murray.

Introduced as "Top Ten Ways Osama bin Laden Can Improve His Image", the list consisted of only one entry: "#10.

This even inspired the Late Show to run a pre-taped bit in 1998, humorously exploring the apparent mystery,[8] and to mention it again on December 29, 1999, when the list "Top Ten Phrases That Were Not Spoken This Millennium", included the #1 entry of, "Why is the number one always so damn funny?"

For nearly two decades each Top Ten list was packaged into a nationally syndicated radio feature, distributed by Westwood One for use the following morning.