| Code | Description | Total Paid |
|---|---|---|
| 90651 | $6K | |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine | $1K |
| E0570 | Nebulizer, with compressor | $830.60 |
| 0011A | $0.00 | |
| 0012A | $0.00 | |
| 0064A | $0.00 | |
| 0124A | $0.00 | |
| 91306 | $0.00 |
| # | Provider | Location | Claims | Total Paid |
|---|---|---|---|---|
| 1 | DKY ENTERPRISES INC. | BROOKLYN, NY | 179 | $8K |
| 2 | MISSOURI LTC PHARMACY LLC | BROOKLINE, MO | 528 | $0.00 |