| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 67028 |
Intravitreal injection of a pharmacologic agent |
564 |
416 |
$74K |
| 92134 |
|
1,312 |
1,160 |
$25K |
| J0178 |
Injection, aflibercept, 1 mg |
20 |
12 |
$24K |
| J9035 |
Injection, bevacizumab, 10 mg |
222 |
150 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
320 |
293 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
192 |
172 |
$10K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
72 |
65 |
$4K |
| 92202 |
|
613 |
554 |
$4K |
| 5010F |
|
21 |
12 |
$0.00 |
| 4040F |
|
99 |
86 |
$0.00 |
| 2022F |
|
30 |
26 |
$0.00 |
| G8483 |
Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons) |
16 |
14 |
$0.00 |
| 2021F |
|
21 |
12 |
$0.00 |
| 1036F |
|
155 |
133 |
$0.00 |
| G8428 |
Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given |
265 |
214 |
$0.00 |
| G8397 |
Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy |
21 |
12 |
$0.00 |