| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic service |
74,262 |
59,150 |
$13.33M |
| 00003 |
|
26,248 |
21,846 |
$4.95M |
| 99213 |
|
25,106 |
18,876 |
$249K |
| 90834 |
|
9,443 |
3,368 |
$230K |
| 99214 |
|
16,093 |
10,528 |
$152K |
| 59425 |
|
3,719 |
2,461 |
$146K |
| 92004 |
|
5,777 |
4,010 |
$106K |
| V2020 |
Vision svcs frames purchases |
8,157 |
5,691 |
$89K |
| 92014 |
|
4,838 |
3,256 |
$84K |
| G0467 |
Fqhc visit, estab pt |
5,246 |
4,673 |
$56K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,346 |
2,651 |
$55K |
| 0002A |
|
609 |
609 |
$41K |
| 0001A |
|
605 |
605 |
$41K |
| 92015 |
|
10,020 |
6,819 |
$35K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
802 |
457 |
$27K |
| V2784 |
Lens polycarb or equal |
5,604 |
2,464 |
$21K |
| 90686 |
|
1,575 |
1,227 |
$21K |
| 99212 |
|
1,773 |
1,361 |
$14K |
| G9920 |
Scrning perf and negative |
1,823 |
1,216 |
$10K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
823 |
446 |
$10K |
| V2100 |
Lens spher single plano 4.00 |
818 |
425 |
$9K |
| 59430 |
|
163 |
147 |
$8K |
| J3490 |
Drugs unclassified injection |
472 |
377 |
$7K |
| G2025 |
Dis site tele svcs rhc/fqhc |
248 |
179 |
$7K |
| H1003 |
Prenatal at risk education |
528 |
233 |
$6K |
| 99000 |
|
7,377 |
5,632 |
$6K |
| 90791 |
|
111 |
69 |
$6K |
| 96110 |
|
753 |
433 |
$5K |
| 92551 |
|
2,919 |
2,000 |
$5K |
| J7307 |
Etonogestrel implant system |
16 |
12 |
$4K |
| 81025 |
|
2,408 |
1,957 |
$4K |
| 0012A |
|
63 |
63 |
$4K |
| 0011A |
|
63 |
63 |
$4K |
| 90832 |
|
159 |
79 |
$4K |
| 90715 |
|
190 |
118 |
$3K |
| 92340 |
|
287 |
180 |
$3K |
| 99205 |
Prolong outpt/office vis |
254 |
158 |
$2K |
| 0071A |
|
36 |
36 |
$2K |
| 0004A |
|
36 |
36 |
$2K |
| V2303 |
Lens sphcy trifocal 4.0/.12- |
273 |
135 |
$2K |
| 0072A |
|
33 |
32 |
$2K |
| 90746 |
|
33 |
26 |
$2K |
| 99391 |
|
560 |
416 |
$2K |
| 99215 |
Prolong outpt/office vis |
447 |
328 |
$2K |
| 0054A |
|
28 |
28 |
$1K |
| 0124A |
|
34 |
34 |
$1K |
| 90471 |
|
7,448 |
5,658 |
$907.56 |
| 99203 |
|
54 |
52 |
$743.60 |
| 99392 |
|
1,078 |
786 |
$631.91 |
| 92083 |
|
78 |
50 |
$498.25 |
| 96372 |
|
132 |
81 |
$495.00 |
| 85018 |
|
7,464 |
5,459 |
$475.80 |
| 81003 |
|
1,635 |
1,278 |
$459.05 |
| 83036 |
|
1,020 |
820 |
$331.12 |
| 99393 |
|
775 |
562 |
$314.62 |
| 99211 |
|
443 |
250 |
$257.76 |
| V2744 |
Tint photochromatic lens/es |
265 |
103 |
$233.48 |
| 99394 |
|
292 |
228 |
$164.49 |
| 99401 |
|
13 |
12 |
$151.42 |
| 99188 |
|
230 |
205 |
$147.60 |
| 90472 |
|
4,149 |
2,033 |
$85.60 |
| V2781 |
Progressive lens per lens |
248 |
108 |
$60.00 |
| V2750 |
Anti-reflective coating |
249 |
111 |
$55.20 |
| 81002 |
|
547 |
472 |
$27.52 |
| 87804 |
|
200 |
60 |
$10.62 |
| 3008F |
|
5,102 |
4,561 |
$0.00 |
| 3074F |
|
3,684 |
3,295 |
$0.00 |
| 36415 |
|
2,059 |
1,983 |
$0.00 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
2,137 |
809 |
$0.00 |
| 3079F |
|
1,425 |
1,354 |
$0.00 |
| 36416 |
|
2,956 |
2,371 |
$0.00 |
| Z1038 |
|
349 |
333 |
$0.00 |
| 3075F |
|
325 |
319 |
$0.00 |
| Z1034 |
|
2,728 |
1,902 |
$0.00 |
| 1111F |
|
676 |
602 |
$0.00 |
| 3080F |
|
426 |
270 |
$0.00 |
| Z6410 |
|
518 |
230 |
$0.00 |
| Z1032 |
|
287 |
287 |
$0.00 |
| 96127 |
|
13 |
13 |
$0.00 |
| G0008 |
Admin influenza virus vac |
26 |
26 |
$0.00 |
| 90656 |
|
44 |
44 |
$0.00 |
| 99999 |
|
52 |
32 |
$0.00 |
| 99173 |
|
2,793 |
1,854 |
$0.00 |
| 59426 |
|
640 |
356 |
$0.00 |
| 3077F |
|
924 |
664 |
$0.00 |
| 1159F |
|
15,664 |
10,678 |
$0.00 |
| 3078F |
|
2,845 |
2,575 |
$0.00 |
| 1160F |
|
15,663 |
10,677 |
$0.00 |
| G0071 |
Comm svcs by rhc/fqhc 5 min |
57 |
33 |
$0.00 |
| 90473 |
|
77 |
51 |
$0.00 |
| Z6400 |
|
41 |
38 |
$0.00 |
| 96160 |
|
98 |
88 |
$0.00 |
| G0101 |
Ca screen;pelvic/breast exam |
101 |
101 |
$0.00 |
| 87880 |
|
12 |
12 |
$0.00 |
| A4649 |
Surgical supplies |
25 |
25 |
$0.00 |
| Z6300 |
|
12 |
12 |
$0.00 |