| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J7503 |
Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg |
491 |
335 |
$38K |
| J7507 |
Tacrolimus, immediate release, oral, 1 mg |
4,513 |
3,345 |
$38K |
| J7518 |
Mycophenolic acid, oral, 180 mg |
923 |
836 |
$34K |
| J7517 |
Mycophenolate mofetil, oral, 250 mg |
2,202 |
2,037 |
$23K |
| Q0511 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period |
4,285 |
3,954 |
$14K |
| Q0512 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period |
5,588 |
3,698 |
$14K |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
2,850 |
2,599 |
$360.40 |
| J7500 |
Azathioprine, oral, 50 mg |
14 |
12 |
$352.92 |
| Q0510 |
Pharmacy supply fee for initial immunosuppressive drug(s), first month following transplant |
41 |
40 |
$100.00 |
| E1399 |
Durable medical equipment, miscellaneous |
55 |
24 |
$0.00 |