| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7503 |
Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg |
33 |
29 |
$4K |
| J7518 |
Mycophenolic acid, oral, 180 mg |
27 |
27 |
$372.90 |
| J7507 |
Tacrolimus, immediate release, oral, 1 mg |
34 |
33 |
$315.07 |
| J7517 |
Mycophenolate mofetil, oral, 250 mg |
27 |
27 |
$285.92 |
| Q0511 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period |
44 |
44 |
$177.60 |
| Q0512 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period |
63 |
41 |
$137.60 |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
13 |
13 |
$2.40 |