| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0012A |
|
48 |
48 |
$760.00 |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
27 |
27 |
$492.03 |
| 0011A |
|
45 |
43 |
$298.90 |
| 90674 |
|
33 |
28 |
$206.46 |
| Q0513 |
Pharmacy dispensing fee for inhalation drug(s); per 30 days |
13 |
13 |
$171.60 |
| K1034 |
Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count |
240 |
240 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$0.00 |