| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4105 |
Enzyme cartridge enteral nut |
977 |
918 |
$6.29M |
| Z5999 |
|
5,582 |
4,771 |
$739K |
| J7639 |
Dornase alfa non-comp unit |
1,080 |
827 |
$557K |
| J7131 |
Hypertonic saline sol |
11,120 |
10,471 |
$547K |
| J7507 |
Tacrolimus imme rel oral 1mg |
13,144 |
10,644 |
$170K |
| J7517 |
Mycophenolate mofetil oral |
7,572 |
6,884 |
$130K |
| J7518 |
Mycophenolic acid |
2,292 |
2,093 |
$123K |
| J7503 |
Tacrol envarsus ex rel oral |
977 |
651 |
$79K |
| Q0511 |
Sup fee antiem,antica,immuno |
11,799 |
11,344 |
$61K |
| Q0512 |
Px sup fee anti-can sub pres |
12,699 |
10,822 |
$59K |
| Q0513 |
Disp fee inhal drugs/30 days |
807 |
780 |
$55K |
| A7005 |
Nondisposable nebulizer set |
1,613 |
955 |
$36K |
| J7512 |
Prednisone ir or dr oral 1mg |
6,541 |
5,895 |
$20K |
| A4209 |
5+ cc sterile syringe&needle |
395 |
366 |
$4K |
| J7520 |
Sirolimus, oral |
59 |
50 |
$4K |
| A4208 |
3 cc sterile syringe&needle |
884 |
828 |
$4K |
| A4215 |
Sterile needle |
40 |
39 |
$2K |
| A7013 |
Disposable compressor filter |
161 |
154 |
$1K |
| A7015 |
Aerosol mask used w nebulize |
553 |
511 |
$1K |
| J7515 |
Cyclosporine oral 25 mg |
29 |
25 |
$474.26 |
| A4206 |
1 cc sterile syringe&needle |
47 |
40 |
$61.87 |
| J7613 |
Albuterol non-comp unit |
44 |
41 |
$44.33 |