| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| A4239 |
Non-adju cgm supply allow |
674 |
662 |
$27K |
| J7507 |
Tacrolimus imme rel oral 1mg |
5,275 |
4,765 |
$19K |
| J7517 |
Mycophenolate mofetil oral |
4,482 |
4,212 |
$13K |
| Q0511 |
Sup fee antiem,antica,immuno |
6,046 |
5,657 |
$8K |
| A4253 |
Blood glucose/reagent strips |
1,224 |
1,206 |
$6K |
| Q0512 |
Px sup fee anti-can sub pres |
10,274 |
5,564 |
$6K |
| J7503 |
Tacrol envarsus ex rel oral |
516 |
440 |
$5K |
| A4215 |
Sterile needle |
27 |
27 |
$847.21 |
| J7512 |
Prednisone ir or dr oral 1mg |
4,372 |
4,111 |
$614.70 |
| A4259 |
Lancets per box |
355 |
350 |
$548.19 |
| K0553 |
Ther cgm supply allowance |
14 |
14 |
$507.77 |