| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7503 |
Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg |
2,238 |
1,938 |
$188K |
| J7507 |
Tacrolimus, immediate release, oral, 1 mg |
6,523 |
5,685 |
$56K |
| J7517 |
Mycophenolate mofetil, oral, 250 mg |
6,639 |
6,264 |
$45K |
| J7518 |
Mycophenolic acid, oral, 180 mg |
525 |
480 |
$10K |
| Q0511 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period |
8,080 |
7,835 |
$8K |
| Q0512 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period |
11,232 |
9,267 |
$5K |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
2,304 |
2,077 |
$1K |
| 99199 |
Unlisted special service, procedure or report |
134 |
98 |
$703.58 |