| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7503 |
Tacrol envarsus ex rel oral |
1,137 |
781 |
$93K |
| J7507 |
Tacrolimus imme rel oral 1mg |
2,952 |
2,424 |
$33K |
| J7517 |
Mycophenolate mofetil oral |
2,313 |
2,007 |
$32K |
| J7518 |
Mycophenolic acid |
862 |
796 |
$28K |
| Q0511 |
Sup fee antiem,antica,immuno |
4,709 |
4,264 |
$22K |
| Q0512 |
Px sup fee anti-can sub pres |
5,410 |
3,720 |
$19K |
| J7508 |
Tacrol astagraf ex rel oral |
120 |
92 |
$2K |
| J7512 |
Prednisone ir or dr oral 1mg |
2,077 |
1,839 |
$1K |
| A4253 |
Blood glucose/reagent strips |
439 |
419 |
$1K |
| Q0513 |
Disp fee inhal drugs/30 days |
150 |
139 |
$732.66 |
| A4259 |
Lancets per box |
24 |
24 |
$2.01 |
| 90480 |
|
13 |
13 |
$0.00 |
| 91320 |
|
12 |
12 |
$0.00 |