| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4215 |
Sterile needle |
1,929 |
1,791 |
$32K |
| J7503 |
Tacrol envarsus ex rel oral |
742 |
460 |
$32K |
| A4253 |
Blood glucose/reagent strips |
2,142 |
1,972 |
$29K |
| A4259 |
Lancets per box |
1,631 |
1,539 |
$6K |
| J7507 |
Tacrolimus imme rel oral 1mg |
3,701 |
2,751 |
$6K |
| J7517 |
Mycophenolate mofetil oral |
3,050 |
2,679 |
$5K |
| 0001A |
|
68 |
68 |
$3K |
| E0607 |
Blood glucose monitor home |
142 |
138 |
$2K |
| A4250 |
Urine reagent strips/tablets |
128 |
122 |
$2K |
| 0004A |
|
43 |
43 |
$2K |
| 0124A |
|
41 |
41 |
$2K |
| 0002A |
|
30 |
30 |
$1K |
| 0054A |
|
29 |
29 |
$1K |
| 0053A |
|
28 |
28 |
$1K |
| A4206 |
1 cc sterile syringe&needle |
57 |
52 |
$1K |
| J7518 |
Mycophenolic acid |
224 |
194 |
$1K |
| A4213 |
20+ cc syringe only |
44 |
42 |
$865.88 |
| 0064A |
|
15 |
15 |
$606.40 |
| J7512 |
Prednisone ir or dr oral 1mg |
2,734 |
2,427 |
$343.20 |
| Q0512 |
Px sup fee anti-can sub pres |
8,739 |
4,021 |
$184.96 |
| Q0511 |
Sup fee antiem,antica,immuno |
3,878 |
3,572 |
$134.90 |