| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7503 |
Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg |
1,137 |
781 |
$93K |
| J7507 |
Tacrolimus, immediate release, oral, 1 mg |
2,952 |
2,424 |
$33K |
| J7517 |
Mycophenolate mofetil, oral, 250 mg |
2,313 |
2,007 |
$32K |
| J7518 |
Mycophenolic acid, oral, 180 mg |
862 |
796 |
$28K |
| Q0511 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period |
4,709 |
4,264 |
$22K |
| Q0512 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period |
5,410 |
3,720 |
$19K |
| J7508 |
Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg |
120 |
92 |
$2K |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
2,077 |
1,839 |
$1K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
439 |
419 |
$1K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
150 |
139 |
$732.66 |
| A4259 |
Lancets, per box of 100 |
24 |
24 |
$2.01 |
| 90480 |
|
13 |
13 |
$0.00 |
| 91320 |
|
12 |
12 |
$0.00 |