| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 0003A |
|
319 |
316 |
$2K |
| 0124A |
|
255 |
254 |
$2K |
| 0054A |
|
104 |
104 |
$1K |
| 91322 |
|
276 |
275 |
$518.47 |
| 0053A |
|
50 |
43 |
$440.00 |
| 0013A |
|
90 |
90 |
$400.00 |
| 0071A |
|
15 |
15 |
$400.00 |
| 0072A |
|
16 |
16 |
$400.00 |
| 90688 |
|
167 |
167 |
$139.37 |
| 91320 |
|
22 |
22 |
$131.10 |
| 0134A |
|
12 |
12 |
$120.00 |
| 0001A |
|
55 |
55 |
$120.00 |
| 0064A |
|
16 |
16 |
$120.00 |
| 90471 |
|
13 |
13 |
$113.20 |
| 0011A |
|
125 |
125 |
$44.02 |
| 91300 |
|
121 |
115 |
$0.00 |
| 90653 |
|
60 |
60 |
$0.00 |
| 90756 |
|
27 |
27 |
$0.00 |
| 0002A |
|
39 |
39 |
$0.00 |
| 91312 |
|
15 |
14 |
$0.00 |
| 90662 |
|
50 |
50 |
$0.00 |
| 90658 |
|
44 |
44 |
$0.00 |
| 90677 |
|
13 |
13 |
$0.00 |
| 91305 |
|
33 |
26 |
$0.00 |
| 90480 |
|
309 |
308 |
$0.00 |
| M0201 |
Administration of pneumococcal, influenza, hepatitis b, and/or covid-19 vaccine inside a patient's home; reported only once per individual home per date of service when such vaccine administration(s) are performed at the patient's home |
50 |
50 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
603 |
603 |
$0.00 |
| 0012A |
|
121 |
121 |
$0.00 |
| 90694 |
|
217 |
217 |
$0.00 |
| K1034 |
Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count |
19 |
19 |
$0.00 |
| 91307 |
|
54 |
50 |
$0.00 |
| 0031A |
|
35 |
35 |
$0.00 |
| G0009 |
Administration of pneumococcal vaccine |
13 |
13 |
$0.00 |