| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7518 |
Mycophenolic acid, oral, 180 mg |
2,161 |
1,928 |
$98K |
| J7517 |
Mycophenolate mofetil, oral, 250 mg |
4,878 |
4,322 |
$88K |
| J7507 |
Tacrolimus, immediate release, oral, 1 mg |
9,829 |
7,228 |
$81K |
| J7503 |
Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg |
597 |
452 |
$67K |
| Q0511 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period |
8,513 |
7,745 |
$29K |
| Q0512 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period |
11,930 |
7,491 |
$29K |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
5,728 |
5,168 |
$2K |
| J7500 |
Azathioprine, oral, 50 mg |
14 |
12 |
$1K |
| J7515 |
Cyclosporine, oral, 25 mg |
41 |
37 |
$523.14 |
| Q0510 |
Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant |
38 |
36 |
$110.00 |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
48 |
46 |
$106.73 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
14 |
13 |
$59.40 |
| E1399 |
Durable medical equipment, miscellaneous |
34 |
13 |
$0.00 |