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CPT CODE DOS(DATE OF SERVICE) DESCRIPTION OF SERVICE

2/19/23-2/25/23
G2067 Med assist tx meth wk
2/23/23
G1028 Take home supply 8mg per 0.1
2/26/23-3/4/23
G2067 Med assist tx meth wk
3/5/23-3/11/23
G2067 Med assist tx meth wk
3/6/23
G2080 Add 30 mins counsel
3/8/23
G2077 Periodic assessment
3/12/23-3/17/23
G2078 Take-home meth
QUA(QUANITITY) TOTAL AMOUNT

1 $215.67

1 $127.58

1 $215.67

1 $215.67

1 $32.03

1 $114.17

1 $37.38

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