| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7503 |
Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg |
7,484 |
6,157 |
$794K |
| J7518 |
Mycophenolic acid, oral, 180 mg |
12,748 |
11,284 |
$398K |
| J7507 |
Tacrolimus, immediate release, oral, 1 mg |
14,700 |
11,702 |
$144K |
| Q0511 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period |
22,425 |
20,734 |
$83K |
| Q0512 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period |
37,933 |
20,134 |
$61K |
| J7500 |
Azathioprine, oral, 50 mg |
1,685 |
1,536 |
$55K |
| J7517 |
Mycophenolate mofetil, oral, 250 mg |
2,219 |
2,024 |
$23K |
| T2029 |
Specialized medical equipment, not otherwise specified, waiver |
216 |
208 |
$21K |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
19,525 |
17,825 |
$6K |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
603 |
565 |
$5K |
| A4253 |
Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips |
1,016 |
939 |
$5K |
| A5500 |
For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoe |
69 |
50 |
$2K |
| A5512 |
For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, each |
27 |
24 |
$942.53 |
| J7515 |
Cyclosporine, oral, 25 mg |
54 |
37 |
$457.81 |
| J7613 |
Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg |
62 |
54 |
$242.32 |
| J7502 |
Cyclosporine, oral, 100 mg |
13 |
12 |
$132.24 |
| A4259 |
Lancets, per box of 100 |
203 |
184 |
$81.85 |