| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7503 |
Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg |
689 |
516 |
$147K |
| J7507 |
Tacrolimus, immediate release, oral, 1 mg |
4,619 |
3,606 |
$105K |
| J7517 |
Mycophenolate mofetil, oral, 250 mg |
3,658 |
3,459 |
$93K |
| Q0511 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period |
5,718 |
5,486 |
$33K |
| 0450 |
Emergency room services |
539 |
506 |
$18K |
| J7518 |
Mycophenolic acid, oral, 180 mg |
178 |
167 |
$9K |
| Q0512 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period |
4,101 |
3,019 |
$9K |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
2,837 |
2,665 |
$8K |
| 0760 |
|
171 |
149 |
$4K |
| A4215 |
Needle, sterile, any size, each |
145 |
143 |
$4K |
| 0270 |
|
87 |
71 |
$1K |
| 85025 |
Blood count; complete (CBC), automated, and automated differential WBC count |
274 |
249 |
$508.95 |
| 80053 |
Comprehensive metabolic panel |
140 |
125 |
$313.52 |
| 91320 |
|
130 |
130 |
$281.26 |
| 90480 |
|
94 |
94 |
$216.52 |
| 81003 |
|
45 |
43 |
$23.94 |
| J3490 |
Unclassified drugs |
546 |
348 |
$18.88 |
| 81025 |
|
13 |
13 |
$11.20 |
| G0008 |
Administration of influenza virus vaccine |
16 |
16 |
$0.00 |
| 99281 |
Emergency department visit for the evaluation and management, self-limited or minor |
429 |
406 |
$0.00 |
| 90662 |
|
56 |
56 |
$0.00 |