| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 11721 |
|
3,130 |
3,057 |
$65K |
| 92015 |
Determination of refractive state |
2,794 |
2,729 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
2,043 |
2,042 |
$30K |
| 11730 |
|
531 |
521 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,673 |
1,672 |
$25K |
| 92341 |
|
884 |
879 |
$20K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
302 |
298 |
$18K |
| D1110 |
Prophylaxis - adult |
500 |
499 |
$11K |
| 92557 |
|
397 |
396 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
148 |
138 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
131 |
131 |
$5K |
| 17250 |
|
309 |
301 |
$5K |
| 92567 |
|
437 |
436 |
$3K |
| 11055 |
|
76 |
76 |
$2K |
| 92553 |
|
94 |
94 |
$2K |
| 92002 |
|
40 |
40 |
$2K |
| 99308 |
Subsequent nursing facility care, per day, straightforward |
48 |
48 |
$1K |
| 11720 |
|
76 |
76 |
$1K |
| 99307 |
|
48 |
48 |
$1K |
| 11056 |
|
31 |
31 |
$1K |
| 99309 |
Subsequent nursing facility care, per day, low to moderate complexity |
17 |
17 |
$766.65 |
| 99304 |
|
37 |
26 |
$729.04 |
| 92555 |
|
46 |
46 |
$565.87 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$333.06 |
| 92250 |
|
17 |
16 |
$75.48 |
| G8415 |
Footwear evaluation was not performed |
142 |
139 |
$0.00 |
| G8404 |
Lower extremity neurological exam performed and documented |
71 |
65 |
$0.00 |