| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99211 |
|
16,919 |
15,721 |
$254K |
| V2020 |
Vision svcs frames purchases |
6,909 |
6,891 |
$161K |
| 92340 |
|
5,027 |
5,016 |
$99K |
| 0012A |
|
1,546 |
1,524 |
$55K |
| 0011A |
|
1,696 |
1,693 |
$54K |
| 92341 |
|
1,943 |
1,941 |
$43K |
| 99000 |
|
2,970 |
2,681 |
$37K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,228 |
3,213 |
$36K |
| 77067 |
|
558 |
558 |
$24K |
| 76805 |
|
454 |
453 |
$22K |
| 76816 |
|
554 |
522 |
$22K |
| 83036 |
|
5,099 |
5,074 |
$21K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,437 |
1,424 |
$18K |
| S0581 |
Nonstnd lens |
1,870 |
1,863 |
$17K |
| 76817 |
|
433 |
376 |
$14K |
| 0064A |
|
400 |
396 |
$12K |
| 76801 |
|
306 |
303 |
$12K |
| V2100 |
Lens spher single plano 4.00 |
1,365 |
1,359 |
$11K |
| 82962 |
|
7,495 |
6,992 |
$11K |
| 99214 |
|
194 |
182 |
$11K |
| 76830 |
|
219 |
214 |
$9K |
| 81025 |
|
1,283 |
1,245 |
$9K |
| G0467 |
Fqhc visit, estab pt |
144 |
123 |
$8K |
| 76819 |
|
308 |
167 |
$8K |
| 99213 |
|
139 |
130 |
$6K |
| 80305 |
|
517 |
452 |
$5K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
237 |
235 |
$4K |
| 85610 |
|
1,129 |
580 |
$4K |
| 81003 |
|
2,174 |
2,120 |
$4K |
| 0071A |
|
136 |
133 |
$3K |
| 0001A |
|
100 |
99 |
$3K |
| 0072A |
|
99 |
97 |
$3K |
| V2200 |
Lens spher bifoc plano 4.00d |
252 |
251 |
$2K |
| 99402 |
|
56 |
52 |
$2K |
| 99001 |
|
256 |
247 |
$2K |
| J1050 |
Medroxyprogesterone acetate |
34 |
34 |
$2K |
| 76815 |
|
63 |
61 |
$2K |
| 0002A |
|
70 |
69 |
$2K |
| 87880 |
|
132 |
131 |
$2K |
| V2107 |
Spherocylinder 4.25d/12-2d |
97 |
97 |
$2K |
| 96372 |
|
269 |
246 |
$2K |
| 85018 |
|
668 |
636 |
$1K |
| 82044 |
|
401 |
401 |
$1K |
| 72110 |
|
60 |
60 |
$1K |
| 73564 |
|
48 |
43 |
$869.18 |
| 77063 |
|
83 |
83 |
$841.25 |
| 0031A |
|
22 |
22 |
$821.58 |
| 0054A |
|
30 |
29 |
$792.93 |
| 82948 |
|
245 |
229 |
$731.80 |
| 0004A |
|
21 |
19 |
$609.59 |
| 77066 |
Tomosynthesis, mammo |
12 |
12 |
$595.53 |
| 71046 |
|
56 |
56 |
$592.79 |
| V2745 |
Tint, any color/solid/grad |
74 |
74 |
$499.40 |
| 97110 |
|
31 |
13 |
$482.44 |
| 81002 |
|
153 |
152 |
$416.75 |
| 92133 |
|
77 |
71 |
$355.48 |
| 81001 |
|
151 |
150 |
$346.62 |
| 82274 |
|
29 |
29 |
$340.53 |
| 0134A |
|
13 |
13 |
$299.84 |
| V2744 |
Tint photochromatic lens/es |
13 |
13 |
$155.20 |
| 73030 |
|
12 |
12 |
$137.88 |
| 96127 |
|
44 |
43 |
$127.52 |
| 3051F |
|
574 |
572 |
$0.55 |
| 3052F |
|
202 |
202 |
$0.19 |
| 91306 |
|
291 |
287 |
$0.03 |
| 91301 |
|
2,890 |
2,840 |
$0.01 |
| 91305 |
|
31 |
30 |
$0.01 |
| 3044F |
|
2,734 |
2,715 |
$0.00 |
| 1111F |
|
1,143 |
1,092 |
$0.00 |
| V2784 |
Lens polycarb or equal |
316 |
311 |
$0.00 |
| 3074F |
|
323 |
278 |
$0.00 |
| 3008F |
|
437 |
379 |
$0.00 |
| 91307 |
|
240 |
226 |
$0.00 |
| V2781 |
Progressive lens per lens |
12 |
12 |
$0.00 |
| 3075F |
|
14 |
13 |
$0.00 |
| 3079F |
|
59 |
57 |
$0.00 |
| 1160F |
|
64 |
61 |
$0.00 |
| 3046F |
|
743 |
735 |
$0.00 |
| 3078F |
|
285 |
251 |
$0.00 |
| 91300 |
|
183 |
177 |
$0.00 |
| 91313 |
|
14 |
14 |
$0.00 |
| 92015 |
|
27 |
26 |
$0.00 |
| 92014 |
|
25 |
25 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
12 |
12 |
$0.00 |