| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 90378 |
|
575 |
452 |
$1.39M |
| J7518 |
Mycophenolic acid, oral, 180 mg |
6,626 |
5,878 |
$364K |
| J7503 |
Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg |
3,268 |
1,962 |
$237K |
| J7507 |
Tacrolimus, immediate release, oral, 1 mg |
10,818 |
8,212 |
$125K |
| J7517 |
Mycophenolate mofetil, oral, 250 mg |
4,419 |
3,662 |
$68K |
| J7520 |
Sirolimus, oral, 1 mg |
697 |
619 |
$47K |
| Q0511 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period |
13,089 |
11,522 |
$41K |
| Q0512 |
Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period |
18,592 |
11,019 |
$35K |
| J2315 |
Injection, naltrexone, depot form, 1 mg |
35 |
26 |
$23K |
| J7527 |
Everolimus, oral, 0.25 mg |
65 |
38 |
$9K |
| A4221 |
Supplies for maintenance of non-insulin drug infusion catheter, per week (list drugs separately) |
589 |
512 |
$3K |
| J7515 |
Cyclosporine, oral, 25 mg |
172 |
156 |
$3K |
| J7512 |
Prednisone, immediate release or delayed release, oral, 1 mg |
5,424 |
4,537 |
$3K |
| J7502 |
Cyclosporine, oral, 100 mg |
108 |
87 |
$3K |