| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens polycarb or equal |
13,633 |
7,148 |
$459K |
| V2100 |
Lens spher single plano 4.00 |
8,633 |
4,116 |
$134K |
| X0620 |
|
649 |
573 |
$129K |
| 0202U |
|
409 |
403 |
$80K |
| T1015 |
Clinic service |
3,077 |
2,766 |
$69K |
| U0004 |
Cov-19 test non-cdc hgh thru |
802 |
788 |
$66K |
| V2020 |
Vision svcs frames purchases |
7,810 |
7,278 |
$60K |
| U0003 |
Cov-19 amp prb hgh thruput |
601 |
589 |
$48K |
| L4386 |
Non-pneum walk boot pre cst |
314 |
308 |
$37K |
| 77067 |
|
364 |
364 |
$36K |
| 17110 |
|
491 |
463 |
$35K |
| 90670 |
|
519 |
517 |
$33K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
816 |
762 |
$28K |
| Q3014 |
Telehealth facility fee |
1,619 |
1,581 |
$22K |
| X0592 |
|
531 |
482 |
$22K |
| 90686 |
|
1,925 |
1,909 |
$22K |
| G0008 |
Admin influenza virus vac |
1,638 |
1,617 |
$20K |
| 76642 |
|
423 |
347 |
$20K |
| 84443 |
|
980 |
953 |
$19K |
| 77066 |
Tomosynthesis, mammo |
166 |
166 |
$18K |
| 90723 |
|
395 |
393 |
$18K |
| U0005 |
Infec agen detec ampli probe |
1,277 |
1,248 |
$18K |
| 20610 |
|
1,061 |
778 |
$17K |
| 80053 |
|
1,766 |
1,723 |
$17K |
| 90651 |
|
123 |
123 |
$17K |
| 67028 |
|
216 |
208 |
$16K |
| L3908 |
Who cock-up nonmolde pre ots |
303 |
262 |
$15K |
| 73610 |
|
696 |
643 |
$14K |
| G0463 |
Hospital outpt clinic visit |
1,111 |
877 |
$14K |
| 73721 |
|
55 |
54 |
$14K |
| 77063 |
|
363 |
363 |
$14K |
| 320 |
|
91 |
73 |
$13K |
| 80061 |
|
1,051 |
1,033 |
$13K |
| 0100U |
|
30 |
28 |
$12K |
| G0279 |
Tomosynthesis, mammo |
340 |
338 |
$12K |
| V2200 |
Lens spher bifoc plano 4.00d |
533 |
280 |
$11K |
| 72082 |
|
271 |
267 |
$11K |
| 73630 |
|
1,048 |
918 |
$11K |
| 62323 |
|
156 |
155 |
$11K |
| 92134 |
|
849 |
814 |
$11K |
| 90680 |
|
287 |
287 |
$11K |
| 77065 |
Tomosynthesis, mammo |
98 |
98 |
$9K |
| 97165 |
|
159 |
159 |
$9K |
| 92133 |
|
394 |
374 |
$8K |
| 82306 |
|
261 |
256 |
$8K |
| G0009 |
Admin pneumococcal vaccine |
456 |
439 |
$7K |
| 11102 |
|
237 |
230 |
$6K |
| 11900 |
|
85 |
85 |
$6K |
| 90472 |
|
483 |
482 |
$6K |
| V2101 |
Single visn sphere 4.12-7.00 |
332 |
165 |
$6K |
| 85025 |
|
1,254 |
1,208 |
$6K |
| 73564 |
|
304 |
254 |
$6K |
| 90647 |
|
325 |
323 |
$6K |
| 73030 |
|
389 |
347 |
$6K |
| 83036 |
|
923 |
892 |
$5K |
| 90471 |
|
525 |
522 |
$5K |
| 73562 |
|
274 |
242 |
$5K |
| 90633 |
|
85 |
85 |
$5K |
| 90734 |
|
55 |
55 |
$5K |
| 36415 |
|
2,875 |
2,734 |
$5K |
| 87631 |
|
32 |
32 |
$4K |
| 0124A |
|
125 |
115 |
$4K |
| L1902 |
Afo ankle gauntlet pre ots |
66 |
58 |
$4K |
| 88305 |
|
789 |
729 |
$4K |
| 87491 |
|
154 |
152 |
$3K |
| 92014 |
|
180 |
165 |
$3K |
| 82607 |
|
284 |
276 |
$3K |
| 72170 |
|
241 |
240 |
$3K |
| 80048 |
|
415 |
407 |
$3K |
| 73110 |
|
221 |
201 |
$3K |
| 0001A |
|
68 |
68 |
$3K |
| 83655 |
|
265 |
261 |
$3K |
| 0072A |
|
64 |
64 |
$3K |
| 90473 |
|
261 |
248 |
$3K |
| 92083 |
|
46 |
46 |
$3K |
| J1020 |
Methylprednisolone 20 mg inj |
1,106 |
1,051 |
$2K |
| 0004A |
|
56 |
56 |
$2K |
| 87591 |
|
106 |
104 |
$2K |
| X0616 |
|
12 |
12 |
$2K |
| 0002A |
|
46 |
46 |
$2K |
| 20611 |
|
46 |
37 |
$2K |
| 85027 |
|
301 |
295 |
$2K |
| 87086 |
|
265 |
253 |
$2K |
| 0071A |
|
42 |
42 |
$2K |
| 11104 |
|
55 |
55 |
$2K |
| J3301 |
Triamcinolone acet inj nos |
4,418 |
4,304 |
$2K |
| 90716 |
|
13 |
13 |
$2K |
| 73130 |
|
143 |
125 |
$2K |
| 73080 |
|
122 |
116 |
$2K |
| 93005 |
|
192 |
188 |
$2K |
| 90715 |
|
83 |
83 |
$1K |
| 73100 |
|
113 |
100 |
$1K |
| 73560 |
|
139 |
124 |
$1K |
| 72100 |
|
64 |
63 |
$1K |
| 82728 |
|
118 |
117 |
$1K |
| 90696 |
|
12 |
12 |
$1K |
| 90707 |
|
27 |
27 |
$1K |
| 84439 |
|
147 |
143 |
$1K |
| 83540 |
|
139 |
135 |
$964.80 |
| 27096 |
|
12 |
12 |
$934.15 |
| 88312 |
|
28 |
25 |
$903.91 |
| 86480 |
|
13 |
13 |
$821.69 |
| 90700 |
|
12 |
12 |
$781.80 |
| 73590 |
|
61 |
55 |
$765.54 |
| Q9965 |
Locm 100-199mg/ml iodine,1ml |
1,798 |
1,765 |
$719.48 |
| 71046 |
|
32 |
32 |
$674.63 |
| 80307 |
|
13 |
12 |
$662.59 |
| L1820 |
Ko elas w/ condyle pads & jo |
13 |
12 |
$653.50 |
| 87389 |
|
24 |
24 |
$626.84 |
| 81003 |
|
197 |
187 |
$579.32 |
| 31231 |
|
12 |
12 |
$552.73 |
| 20552 |
|
26 |
25 |
$551.29 |
| 86140 |
|
233 |
229 |
$511.86 |
| 83550 |
|
120 |
119 |
$498.35 |
| 85652 |
|
217 |
214 |
$495.42 |
| 92025 |
|
24 |
24 |
$485.12 |
| 81001 |
|
185 |
175 |
$484.29 |
| 73070 |
|
29 |
27 |
$476.17 |
| 87070 |
|
102 |
97 |
$433.95 |
| 87186 |
|
67 |
64 |
$432.82 |
| 86618 |
|
25 |
25 |
$426.35 |
| 82570 |
|
75 |
71 |
$407.15 |
| 85610 |
|
130 |
111 |
$405.29 |
| 73090 |
|
28 |
26 |
$329.39 |
| 72081 |
|
13 |
13 |
$295.98 |
| 87641 |
|
13 |
13 |
$288.41 |
| 80076 |
|
34 |
34 |
$278.35 |
| 84702 |
|
17 |
13 |
$277.95 |
| 82248 |
|
51 |
50 |
$260.56 |
| 20550 |
|
12 |
12 |
$238.40 |
| 90474 |
|
24 |
24 |
$236.00 |
| 82962 |
|
178 |
173 |
$222.72 |
| 73600 |
|
17 |
15 |
$201.03 |
| 73140 |
|
14 |
12 |
$159.83 |
| 83735 |
|
30 |
27 |
$158.61 |
| A9585 |
Gadobutrol injection |
334 |
303 |
$142.67 |
| 36416 |
|
164 |
159 |
$134.20 |
| 85018 |
|
40 |
40 |
$128.90 |
| V2744 |
Tint photochromatic lens/es |
12 |
12 |
$108.35 |
| 84460 |
|
17 |
16 |
$98.82 |
| 87077 |
|
14 |
14 |
$82.14 |
| 84450 |
|
13 |
12 |
$75.77 |
| 87430 |
|
13 |
13 |
$73.67 |
| 84100 |
|
14 |
14 |
$62.65 |
| 81025 |
|
12 |
12 |
$42.04 |
| J1100 |
Dexamethasone sodium phos |
1,231 |
1,204 |
$36.42 |
| J0702 |
Betamethasone acet&sod phosp |
84 |
80 |
$0.00 |
| J0134 |
Inj acetaminophen -fresenius |
219 |
218 |
$0.00 |
| J2405 |
Ondansetron hcl injection |
726 |
712 |
$0.00 |
| V2025 |
Eyeglasses delux frames |
145 |
141 |
$0.00 |
| J0665 |
Inj, bupivacaine, nos, 0.5mg |
1,351 |
1,337 |
$0.00 |
| 90380 |
|
13 |
12 |
$0.00 |
| J1596 |
Inj, glycopyrrolate, 0.1 mg |
91 |
91 |
$0.00 |
| J1171 |
Inj, hydromorphone, 0.1 mg |
14 |
14 |
$0.00 |
| Q9967 |
Locm 300-399mg/ml iodine,1ml |
42 |
42 |
$0.00 |
| Q9966 |
Locm 200-299mg/ml iodine,1ml |
40 |
38 |
$0.00 |
| 91320 |
|
32 |
31 |
$0.00 |
| J0137 |
Inj, acetaminophen (hikma) |
16 |
16 |
$0.00 |
| J0136 |
Inj, acetaminophen (b braun) |
33 |
33 |
$0.00 |
| Q9961 |
Hocm 250-299mg/ml iodine,1ml |
14 |
14 |
$0.00 |
| J0131 |
Inj, acetaminophen (nos) |
31 |
31 |
$0.00 |
| J0690 |
Cefazolin sodium injection |
91 |
91 |
$0.00 |
| J0178 |
Aflibercept injection |
79 |
76 |
$0.00 |
| J2795 |
Ropivacaine hcl injection |
71 |
62 |
$0.00 |
| J1885 |
Ketorolac tromethamine inj |
324 |
322 |
$0.00 |
| J2704 |
Inj, propofol, 10 mg |
1,378 |
1,237 |
$0.00 |
| J3010 |
Fentanyl citrate injection |
372 |
355 |
$0.00 |
| 90656 |
|
403 |
403 |
$0.00 |
| J2250 |
Inj midazolam hydrochloride |
392 |
389 |
$0.00 |
| J1597 |
Inj glycopyrrolate, glyrx-pf |
125 |
125 |
$0.00 |
| J1010 |
Inj, methylpred acetate 1 mg |
325 |
322 |
$0.00 |
| 90677 |
|
193 |
191 |
$0.00 |
| 90480 |
|
60 |
55 |
$0.00 |
| J2003 |
Inj, lidocaine hcl, 1 mg |
93 |
84 |
$0.00 |
| 91305 |
|
38 |
37 |
$0.00 |