| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic service |
95,393 |
81,355 |
$14.74M |
| 00003 |
|
42,421 |
35,201 |
$10.08M |
| 90834 |
|
10,240 |
3,819 |
$347K |
| 92004 |
|
9,995 |
6,509 |
$268K |
| 99213 |
|
43,204 |
31,622 |
$245K |
| 99214 |
|
19,792 |
15,031 |
$211K |
| 92014 |
|
8,472 |
5,575 |
$204K |
| V2020 |
Vision svcs frames purchases |
12,989 |
8,562 |
$175K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
8,319 |
4,077 |
$96K |
| 92015 |
|
19,033 |
12,680 |
$87K |
| 59425 |
|
1,897 |
1,332 |
$86K |
| G0467 |
Fqhc visit, estab pt |
13,086 |
11,338 |
$59K |
| V2784 |
Lens polycarb or equal |
7,011 |
3,087 |
$27K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
863 |
457 |
$25K |
| V2100 |
Lens spher single plano 4.00 |
2,164 |
1,115 |
$23K |
| 90686 |
|
1,518 |
1,347 |
$19K |
| 99212 |
|
6,686 |
4,994 |
$17K |
| G2025 |
Dis site tele svcs rhc/fqhc |
564 |
443 |
$17K |
| 90832 |
|
642 |
309 |
$16K |
| 99205 |
Prolong outpt/office vis |
230 |
155 |
$14K |
| 99204 |
|
211 |
200 |
$13K |
| G9920 |
Scrning perf and negative |
2,163 |
1,853 |
$9K |
| 92340 |
|
608 |
365 |
$9K |
| 99391 |
|
1,558 |
1,135 |
$8K |
| 0012A |
|
81 |
81 |
$5K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
360 |
185 |
$5K |
| 11721 |
|
257 |
181 |
$4K |
| 0011A |
|
62 |
62 |
$4K |
| 99000 |
|
7,778 |
5,705 |
$4K |
| 92341 |
|
108 |
66 |
$3K |
| 90791 |
|
55 |
28 |
$3K |
| 90837 |
|
37 |
26 |
$3K |
| 99392 |
|
1,880 |
1,372 |
$2K |
| H1003 |
Prenatal at risk education |
128 |
76 |
$2K |
| 99244 |
|
329 |
277 |
$2K |
| 92551 |
|
3,348 |
2,545 |
$2K |
| 81025 |
|
851 |
606 |
$1K |
| 99393 |
|
1,263 |
947 |
$1K |
| 99203 |
|
39 |
39 |
$1K |
| 59430 |
|
17 |
12 |
$991.92 |
| V2750 |
Anti-reflective coating |
1,183 |
577 |
$929.20 |
| 96110 |
|
162 |
135 |
$802.66 |
| 99394 |
|
427 |
341 |
$789.60 |
| 92133 |
|
36 |
29 |
$755.01 |
| J3301 |
Triamcinolone acet inj nos |
76 |
75 |
$605.33 |
| 99188 |
|
1,018 |
723 |
$595.60 |
| 17110 |
|
72 |
71 |
$498.90 |
| 85018 |
|
6,676 |
5,157 |
$404.61 |
| 90715 |
|
14 |
12 |
$365.31 |
| 99396 |
|
13 |
13 |
$324.20 |
| V2744 |
Tint photochromatic lens/es |
295 |
142 |
$251.44 |
| 92083 |
|
15 |
12 |
$199.30 |
| 90471 |
|
6,880 |
5,592 |
$174.52 |
| 92012 |
|
14 |
12 |
$152.14 |
| 83036 |
|
579 |
457 |
$130.34 |
| 90472 |
|
3,484 |
1,905 |
$126.00 |
| 99395 |
|
14 |
13 |
$123.48 |
| 99243 |
|
15 |
12 |
$119.00 |
| 96372 |
|
22 |
12 |
$117.00 |
| 93000 |
|
55 |
52 |
$71.90 |
| V2755 |
Uv lens/es |
27 |
18 |
$50.58 |
| 87811 |
|
49 |
46 |
$45.00 |
| 99211 |
|
92 |
56 |
$43.20 |
| 87804 |
|
62 |
32 |
$21.24 |
| 81002 |
|
245 |
212 |
$10.69 |
| 81003 |
|
40 |
37 |
$8.62 |
| 82962 |
|
14 |
14 |
$2.40 |
| 99173 |
|
3,022 |
2,243 |
$2.30 |
| 3074F |
|
4,250 |
3,881 |
$0.00 |
| Z1034 |
|
1,425 |
1,079 |
$0.00 |
| 90656 |
|
76 |
76 |
$0.00 |
| 36416 |
|
3,642 |
3,271 |
$0.00 |
| 3008F |
|
5,467 |
4,974 |
$0.00 |
| 1111F |
|
1,084 |
967 |
$0.00 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
2,150 |
816 |
$0.00 |
| 36415 |
|
2,690 |
2,656 |
$0.00 |
| 3079F |
|
1,506 |
1,464 |
$0.00 |
| Z1038 |
|
48 |
46 |
$0.00 |
| 3075F |
|
488 |
479 |
$0.00 |
| G0008 |
Admin influenza virus vac |
108 |
108 |
$0.00 |
| 86580 |
|
12 |
12 |
$0.00 |
| 3080F |
|
109 |
76 |
$0.00 |
| Z6410 |
|
18 |
14 |
$0.00 |
| Z1032 |
|
26 |
26 |
$0.00 |
| 96127 |
|
25 |
25 |
$0.00 |
| 99999 |
|
32 |
18 |
$0.00 |
| 59426 |
|
55 |
42 |
$0.00 |
| 1160F |
|
18,526 |
13,996 |
$0.00 |
| 1159F |
|
18,528 |
13,998 |
$0.00 |
| 3077F |
|
409 |
364 |
$0.00 |
| 3078F |
|
3,477 |
3,192 |
$0.00 |
| 90473 |
|
448 |
342 |
$0.00 |
| G8483 |
Flu imm no admin doc rea |
104 |
104 |
$0.00 |
| G0071 |
Comm svcs by rhc/fqhc 5 min |
263 |
225 |
$0.00 |
| A4649 |
Surgical supplies |
25 |
25 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
28 |
28 |
$0.00 |
| 96160 |
|
209 |
188 |
$0.00 |
| G0101 |
Ca screen;pelvic/breast exam |
12 |
12 |
$0.00 |
| G8482 |
Flu immunize order/admin |
64 |
64 |
$0.00 |
| G0466 |
Fqhc visit new patient |
49 |
38 |
$0.00 |
| A4550 |
Surgical trays |
13 |
12 |
$0.00 |