| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H2036 |
Alcohol and/or other drug treatment program, per diem |
21,434 |
1,410 |
$3.62M |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
23,557 |
14,165 |
$2.24M |
| H0014 |
Alcohol and/or drug services; ambulatory detoxification |
7,674 |
1,509 |
$1.52M |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12,380 |
8,181 |
$1.11M |
| H0005 |
Alcohol and/or drug services; group counseling by a clinician |
11,698 |
2,664 |
$712K |
| 90832 |
Psychotherapy, 30 minutes with patient |
2,463 |
1,314 |
$478K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,434 |
2,190 |
$347K |
| G0397 |
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes |
1,327 |
784 |
$202K |
| 77067 |
Screening mammography, bilateral, including computer-aided detection |
1,768 |
1,764 |
$190K |
| G0396 |
Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes |
1,412 |
724 |
$154K |
| 90792 |
Psychiatric diagnostic evaluation with medical services |
1,067 |
960 |
$144K |
| 99406 |
|
3,713 |
2,699 |
$84K |
| 90834 |
Psychotherapy, 45 minutes with patient |
184 |
130 |
$28K |
| 99443 |
|
357 |
254 |
$27K |
| 99442 |
|
395 |
279 |
$26K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
278 |
173 |
$25K |
| 90791 |
Psychiatric diagnostic evaluation |
141 |
135 |
$22K |
| D1110 |
Prophylaxis - adult |
132 |
91 |
$14K |
| 80354 |
|
761 |
488 |
$13K |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
171 |
57 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
137 |
137 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
173 |
120 |
$4K |
| 99201 |
|
52 |
25 |
$4K |
| 82962 |
|
298 |
195 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
258 |
241 |
$3K |
| 90674 |
|
155 |
150 |
$2K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
26 |
17 |
$2K |
| 86580 |
|
250 |
227 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
156 |
156 |
$2K |
| D9110 |
|
25 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
72 |
40 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
102 |
101 |
$2K |
| 92015 |
Determination of refractive state |
108 |
108 |
$1K |
| 86703 |
|
61 |
52 |
$1K |
| V2020 |
Frames, purchases |
165 |
165 |
$891.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
18 |
12 |
$824.96 |
| 90632 |
|
17 |
14 |
$774.28 |
| 96372 |
Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular |
44 |
38 |
$617.10 |
| 90853 |
Group psychotherapy (other than of a multiple-family group) |
23 |
13 |
$518.84 |
| 99408 |
|
31 |
25 |
$439.33 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
46 |
45 |
$430.65 |
| 99441 |
|
15 |
12 |
$345.41 |
| 99401 |
|
16 |
15 |
$182.40 |
| 86803 |
|
559 |
553 |
$0.80 |
| 86704 |
|
565 |
559 |
$0.79 |
| 86706 |
|
485 |
480 |
$0.24 |
| 87389 |
Infectious agent antigen detection by immunoassay technique, HIV-1 antigen with HIV-1 and HIV-2 antibodies |
50 |
50 |
$0.00 |
| G8417 |
Bmi is documented above normal parameters and a follow-up plan is documented |
226 |
205 |
$0.00 |