| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
2,271 |
2,032 |
$69K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
591 |
548 |
$41K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
528 |
516 |
$23K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
145 |
137 |
$11K |
| 92551 |
|
26 |
26 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
17 |
17 |
$972.18 |
| 92002 |
|
26 |
26 |
$723.72 |
| G0467 |
Federally qualified health center (fqhc) visit, established patient; a medically-necessary, face-to-face encounter (one-on-one) between an established patient and a fqhc practitioner during which time one or more fqhc services are rendered and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving a fqhc visit |
25 |
18 |
$561.86 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
42 |
41 |
$552.20 |
| 90686 |
|
13 |
13 |
$390.00 |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
29 |
$275.00 |
| 1126F |
|
291 |
262 |
$130.00 |
| 36415 |
Collection of venous blood by venipuncture |
51 |
51 |
$21.18 |
| 99173 |
|
39 |
39 |
$3.33 |
| 92015 |
Determination of refractive state |
1,254 |
968 |
$0.00 |
| 3078F |
|
891 |
798 |
$0.00 |
| 3725F |
|
198 |
181 |
$0.00 |
| 1160F |
|
15 |
15 |
$0.00 |
| 1159F |
|
15 |
15 |
$0.00 |
| 3074F |
|
989 |
873 |
$0.00 |
| 1036F |
|
48 |
41 |
$0.00 |
| 3008F |
|
1,175 |
1,046 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
13 |
12 |
$0.00 |