| Code | Description | Claims | Beneficiaries | Total Paid |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12,096 |
5,956 |
$427K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
6,852 |
2,717 |
$123K |
| 67028 |
Intravitreal injection of a pharmacologic agent |
940 |
790 |
$79K |
| V2020 |
Frames, purchases |
7,258 |
6,060 |
$56K |
| T1015 |
Clinic visit/encounter, all-inclusive |
1,270 |
487 |
$47K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,236 |
1,181 |
$39K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
863 |
846 |
$30K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,780 |
847 |
$27K |
| 92134 |
|
2,259 |
1,998 |
$26K |
| 92133 |
|
881 |
803 |
$11K |
| 20610 |
|
535 |
374 |
$8K |
| 92083 |
|
223 |
204 |
$7K |
| 92250 |
|
211 |
186 |
$7K |
| X0592 |
|
190 |
188 |
$7K |
| 73721 |
Magnetic resonance imaging, any joint of lower extremity; without contrast material |
14 |
14 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
85 |
85 |
$4K |
| X0616 |
|
14 |
13 |
$3K |
| 76770 |
|
51 |
50 |
$2K |
| 76830 |
Ultrasound, transvaginal |
38 |
38 |
$2K |
| 73130 |
|
130 |
118 |
$2K |
| 92082 |
|
90 |
73 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
47 |
45 |
$1K |
| 87086 |
Culture, bacterial; quantitative colony count, urine |
201 |
190 |
$1K |
| 71046 |
Radiologic examination, chest; 2 views |
63 |
63 |
$1K |
| 73610 |
|
53 |
53 |
$1K |
| 76705 |
Ultrasound, abdominal, real time with image documentation; limited |
26 |
26 |
$1K |
| 97165 |
|
12 |
12 |
$772.38 |
| V2201 |
Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens |
24 |
12 |
$556.32 |
| 76536 |
|
12 |
12 |
$547.18 |
| 73630 |
|
18 |
15 |
$525.76 |
| 88305 |
Level IV - Surgical pathology, gross and microscopic examination |
50 |
24 |
$503.74 |
| 73110 |
|
13 |
13 |
$295.46 |
| 81001 |
|
105 |
102 |
$266.87 |
| 92015 |
Determination of refractive state |
13 |
13 |
$216.50 |
| J2250 |
Injection, midazolam hydrochloride, per 1 mg |
1,418 |
1,367 |
$0.00 |
| J0690 |
Injection, cefazolin sodium, 500 mg |
696 |
691 |
$0.00 |
| J2704 |
Injection, propofol, 10 mg |
1,743 |
1,650 |
$0.00 |
| J1885 |
Injection, ketorolac tromethamine, per 15 mg |
325 |
317 |
$0.00 |
| A9585 |
Injection, gadobutrol, 0.1 ml |
458 |
456 |
$0.00 |
| J1100 |
Injection, dexamethasone sodium phosphate, 1 mg |
954 |
930 |
$0.00 |
| J2795 |
Injection, ropivacaine hydrochloride, 1 mg |
168 |
151 |
$0.00 |
| J3010 |
Injection, fentanyl citrate, 0.1 mg |
1,060 |
996 |
$0.00 |
| J1097 |
Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml |
47 |
39 |
$0.00 |
| J2003 |
Injection, lidocaine hydrochloride, 1 mg |
104 |
93 |
$0.00 |
| J0178 |
Injection, aflibercept, 1 mg |
240 |
226 |
$0.00 |
| J0173 |
Injection, epinephrine (belcher), not therapeutically equivalent to j0171, 0.1 mg |
12 |
12 |
$0.00 |
| C9399 |
Unclassified drugs or biologicals |
13 |
13 |
$0.00 |
| Q9967 |
Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml |
750 |
740 |
$0.00 |
| J2405 |
Injection, ondansetron hydrochloride, per 1 mg |
1,240 |
1,190 |
$0.00 |
| J0665 |
Injection, bupivicaine, not otherwise specified, 0.5 mg |
288 |
284 |
$0.00 |
| J3301 |
Injection, triamcinolone acetonide, not otherwise specified, 10 mg |
810 |
781 |
$0.00 |
| C9257 |
Injection, bevacizumab, 0.25 mg |
84 |
82 |
$0.00 |
| J1596 |
Injection, glycopyrrolate, 0.1 mg |
12 |
12 |
$0.00 |
| J0171 |
Injection, adrenalin, epinephrine, 0.1 mg |
22 |
22 |
$0.00 |