| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| B4150 |
Ef complet w/intact nutrient |
423 |
400 |
$65K |
| J7518 |
Mycophenolic acid |
8,032 |
7,320 |
$48K |
| B4035 |
Enteral feed supp pump per d |
230 |
224 |
$35K |
| J7507 |
Tacrolimus imme rel oral 1mg |
9,676 |
8,303 |
$28K |
| B4100 |
Food thickener oral |
376 |
346 |
$27K |
| J7517 |
Mycophenolate mofetil oral |
4,590 |
4,052 |
$9K |
| B4034 |
Enter feed supkit syr by day |
109 |
107 |
$8K |
| J7500 |
Azathioprine oral 50mg |
1,073 |
988 |
$5K |
| A4253 |
Blood glucose/reagent strips |
1,079 |
1,069 |
$3K |
| B4152 |
Ef calorie dense>/=1.5kcal |
26 |
25 |
$3K |
| Q0511 |
Sup fee antiem,antica,immuno |
12,330 |
11,094 |
$2K |
| Q0512 |
Px sup fee anti-can sub pres |
17,347 |
11,343 |
$2K |
| A4215 |
Sterile needle |
41 |
38 |
$2K |
| J7503 |
Tacrol envarsus ex rel oral |
75 |
37 |
$1K |
| J7515 |
Cyclosporine oral 25 mg |
107 |
92 |
$913.69 |
| J7512 |
Prednisone ir or dr oral 1mg |
5,152 |
4,563 |
$578.51 |
| A4259 |
Lancets per box |
241 |
236 |
$388.97 |
| Q0513 |
Disp fee inhal drugs/30 days |
14 |
14 |
$6.60 |
| Q0510 |
Dispens fee immunosupressive |
21 |
17 |
$0.00 |
| J7508 |
Tacrol astagraf ex rel oral |
92 |
55 |
$0.00 |