| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7518 |
Mycophenolic acid |
1,697 |
1,334 |
$108K |
| J7503 |
Tacrol envarsus ex rel oral |
466 |
359 |
$36K |
| A4253 |
Blood glucose/reagent strips |
1,129 |
1,042 |
$30K |
| A4215 |
Sterile needle |
672 |
633 |
$30K |
| J7507 |
Tacrolimus imme rel oral 1mg |
1,479 |
1,227 |
$12K |
| E0607 |
Blood glucose monitor home |
232 |
231 |
$6K |
| A4259 |
Lancets per box |
617 |
596 |
$6K |
| A4627 |
Spacer bag/reservoir |
67 |
67 |
$2K |
| Q0511 |
Sup fee antiem,antica,immuno |
2,151 |
1,874 |
$1K |
| Q0512 |
Px sup fee anti-can sub pres |
3,122 |
1,833 |
$695.74 |
| S8490 |
100 insulin syringes |
14 |
14 |
$372.45 |
| Q0510 |
Dispens fee immunosupressive |
125 |
122 |
$320.00 |
| J7512 |
Prednisone ir or dr oral 1mg |
1,113 |
1,049 |
$240.32 |