| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J2315 |
Naltrexone, depot form |
868 |
764 |
$991K |
| A9276 |
Disposable sensor, cgm sys |
4,587 |
3,721 |
$929K |
| A4230 |
Infus insulin pump non needl |
4,293 |
3,690 |
$507K |
| K0553 |
Ther cgm supply allowance |
8,058 |
6,656 |
$348K |
| A9277 |
External transmitter, cgm |
2,061 |
1,541 |
$329K |
| A4239 |
Non-adju cgm supply allow |
6,451 |
6,113 |
$314K |
| A9274 |
Ext amb insulin delivery sys |
414 |
375 |
$204K |
| A4232 |
Syringe w/needle insulin 3cc |
2,970 |
2,525 |
$105K |
| J7518 |
Mycophenolic acid |
2,304 |
2,070 |
$95K |
| J7507 |
Tacrolimus imme rel oral 1mg |
9,056 |
6,408 |
$74K |
| A9278 |
External receiver, cgm sys |
256 |
240 |
$57K |
| Q0511 |
Sup fee antiem,antica,immuno |
11,601 |
10,491 |
$35K |
| Q0512 |
Px sup fee anti-can sub pres |
13,383 |
9,259 |
$31K |
| A4225 |
Sup/ext insulin inf pump syr |
1,432 |
1,295 |
$30K |
| J7517 |
Mycophenolate mofetil oral |
5,984 |
5,349 |
$28K |
| A4224 |
Supply insulin inf cath/wk |
209 |
193 |
$20K |
| J7515 |
Cyclosporine oral 25 mg |
619 |
577 |
$10K |
| K0554 |
Ther cgm receiver/monitor |
100 |
97 |
$10K |
| E2103 |
Non-adju cgm receiver/mon |
163 |
161 |
$8K |
| J7639 |
Dornase alfa non-comp unit |
13 |
13 |
$7K |
| Q0513 |
Disp fee inhal drugs/30 days |
374 |
352 |
$2K |
| J7512 |
Prednisone ir or dr oral 1mg |
3,313 |
2,910 |
$229.88 |
| A4253 |
Blood glucose/reagent strips |
16 |
13 |
$89.88 |
| Q0510 |
Dispens fee immunosupressive |
33 |
32 |
$40.00 |
| J7613 |
Albuterol non-comp unit |
30 |
27 |
$34.29 |