| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 93000 |
|
125 |
118 |
$833.04 |
| 1158F |
|
159 |
146 |
$228.00 |
| 1157F |
|
134 |
126 |
$228.00 |
| 3048F |
|
71 |
69 |
$200.00 |
| 3079F |
|
332 |
305 |
$150.00 |
| 3078F |
|
237 |
215 |
$130.00 |
| 3074F |
|
220 |
197 |
$130.00 |
| 3075F |
|
287 |
266 |
$108.00 |
| 3077F |
|
14 |
14 |
$3.00 |
| 2028F |
|
22 |
22 |
$0.00 |
| 96160 |
|
144 |
50 |
$0.00 |
| 0521F |
|
84 |
76 |
$0.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
12 |
12 |
$0.00 |
| 1100F |
|
91 |
90 |
$0.00 |
| 2022F |
|
34 |
33 |
$0.00 |
| 1159F |
|
181 |
173 |
$0.00 |
| 1160F |
|
182 |
174 |
$0.00 |
| 1090F |
|
88 |
88 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
14 |
14 |
$0.00 |
| 1125F |
|
101 |
90 |
$0.00 |
| 3061F |
|
40 |
40 |
$0.00 |
| 3008F |
|
151 |
140 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
658 |
527 |
$0.00 |
| Q2036 |
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (flulaval) |
14 |
14 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
53 |
19 |
$0.00 |
| 4010F |
|
13 |
13 |
$0.00 |
| 3017F |
|
64 |
63 |
$0.00 |
| 1170F |
|
164 |
151 |
$0.00 |
| 90656 |
|
20 |
20 |
$0.00 |