| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7503 |
Tacrol envarsus ex rel oral |
7,484 |
6,157 |
$794K |
| J7518 |
Mycophenolic acid |
12,748 |
11,284 |
$398K |
| J7507 |
Tacrolimus imme rel oral 1mg |
14,700 |
11,702 |
$144K |
| Q0511 |
Sup fee antiem,antica,immuno |
22,425 |
20,734 |
$83K |
| Q0512 |
Px sup fee anti-can sub pres |
37,933 |
20,134 |
$61K |
| J7500 |
Azathioprine oral 50mg |
1,685 |
1,536 |
$55K |
| J7517 |
Mycophenolate mofetil oral |
2,219 |
2,024 |
$23K |
| T2029 |
Special med equip, noswaiver |
216 |
208 |
$21K |
| J7512 |
Prednisone ir or dr oral 1mg |
19,525 |
17,825 |
$6K |
| Q0513 |
Disp fee inhal drugs/30 days |
603 |
565 |
$5K |
| A4253 |
Blood glucose/reagent strips |
1,016 |
939 |
$5K |
| A5500 |
Diab shoe for density insert |
69 |
50 |
$2K |
| A5512 |
Multi den insert direct form |
27 |
24 |
$942.53 |
| J7515 |
Cyclosporine oral 25 mg |
54 |
37 |
$457.81 |
| J7613 |
Albuterol non-comp unit |
62 |
54 |
$242.32 |
| J7502 |
Cyclosporine oral 100 mg |
13 |
12 |
$132.24 |
| A4259 |
Lancets per box |
203 |
184 |
$81.85 |