| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens polycarb or equal |
16,722 |
8,559 |
$543K |
| V2101 |
Single visn sphere 4.12-7.00 |
12,085 |
5,806 |
$216K |
| 93797 |
|
3,527 |
631 |
$141K |
| V2020 |
Vision svcs frames purchases |
9,196 |
8,749 |
$68K |
| 67028 |
|
491 |
430 |
$35K |
| Q3014 |
Telehealth facility fee |
2,053 |
2,008 |
$28K |
| J0178 |
Aflibercept injection |
60 |
49 |
$25K |
| 84443 |
|
1,211 |
1,195 |
$25K |
| V2201 |
Lens sphere bifocal 4.12-7.0 |
1,048 |
515 |
$24K |
| 92134 |
|
1,197 |
1,128 |
$22K |
| T1015 |
Clinic service |
1,141 |
1,053 |
$22K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
630 |
589 |
$20K |
| 92133 |
|
779 |
751 |
$19K |
| V2100 |
Lens spher single plano 4.00 |
919 |
459 |
$14K |
| 80053 |
|
1,013 |
981 |
$11K |
| 82306 |
|
221 |
220 |
$8K |
| 96372 |
|
680 |
636 |
$8K |
| 92083 |
|
143 |
137 |
$8K |
| 92014 |
|
314 |
309 |
$8K |
| 97803 |
|
343 |
334 |
$7K |
| 83036 |
|
1,179 |
1,153 |
$7K |
| 77080 |
|
82 |
82 |
$5K |
| 91200 |
|
239 |
231 |
$4K |
| 86200 |
|
266 |
265 |
$4K |
| 86235 |
|
54 |
54 |
$3K |
| 84439 |
|
387 |
380 |
$3K |
| 92250 |
|
88 |
82 |
$3K |
| V2200 |
Lens spher bifoc plano 4.00d |
139 |
66 |
$3K |
| 70486 |
|
46 |
45 |
$3K |
| 80061 |
|
197 |
195 |
$3K |
| 85025 |
|
469 |
456 |
$3K |
| 36415 |
|
1,323 |
1,299 |
$2K |
| 70355 |
|
131 |
131 |
$2K |
| 85027 |
|
293 |
286 |
$2K |
| 82728 |
|
176 |
173 |
$2K |
| G0108 |
Diab manage trn per indiv |
65 |
60 |
$2K |
| 83970 |
|
38 |
38 |
$2K |
| 82607 |
|
123 |
122 |
$2K |
| 80074 |
|
29 |
29 |
$1K |
| 90686 |
|
206 |
203 |
$1K |
| 83540 |
|
160 |
157 |
$1K |
| 86160 |
|
43 |
42 |
$1K |
| 81025 |
|
294 |
282 |
$1K |
| 86431 |
|
168 |
167 |
$1K |
| 86800 |
|
63 |
62 |
$1K |
| 82570 |
|
171 |
169 |
$1K |
| 86140 |
|
388 |
380 |
$1K |
| 85652 |
|
382 |
373 |
$1K |
| 83520 |
|
99 |
99 |
$1K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
27 |
27 |
$947.60 |
| 86708 |
|
68 |
67 |
$882.60 |
| G0480 |
Drug test def 1-7 classes |
12 |
12 |
$813.45 |
| V2744 |
Tint photochromatic lens/es |
85 |
82 |
$807.70 |
| G0008 |
Admin influenza virus vac |
81 |
80 |
$764.04 |
| 83550 |
|
145 |
142 |
$712.06 |
| 86225 |
|
44 |
43 |
$612.00 |
| 82784 |
|
43 |
43 |
$605.65 |
| 82043 |
|
92 |
91 |
$597.33 |
| 85610 |
|
161 |
152 |
$582.31 |
| 86317 |
|
31 |
31 |
$573.20 |
| 86376 |
|
68 |
67 |
$537.11 |
| 20610 |
|
28 |
25 |
$505.40 |
| 86039 |
|
29 |
28 |
$387.00 |
| 82105 |
|
24 |
24 |
$350.19 |
| 92082 |
|
17 |
17 |
$331.25 |
| 82746 |
|
24 |
24 |
$282.61 |
| 88305 |
|
26 |
24 |
$248.58 |
| 86803 |
|
12 |
12 |
$204.25 |
| 84165 |
|
12 |
12 |
$188.12 |
| 90471 |
|
14 |
14 |
$145.40 |
| 82962 |
|
64 |
58 |
$128.16 |
| 80048 |
|
15 |
14 |
$122.94 |
| 83525 |
|
13 |
13 |
$120.95 |
| C9257 |
Bevacizumab injection |
64 |
63 |
$75.02 |
| 81001 |
|
25 |
25 |
$74.95 |
| J3420 |
Vitamin b12 injection |
779 |
763 |
$56.04 |
| 92015 |
|
12 |
12 |
$52.12 |
| G0463 |
Hospital outpt clinic visit |
440 |
384 |
$48.18 |
| 86592 |
|
13 |
12 |
$39.00 |
| V2025 |
Eyeglasses delux frames |
75 |
75 |
$0.00 |
| V2750 |
Anti-reflective coating |
29 |
29 |
$0.00 |
| 90656 |
|
43 |
43 |
$0.00 |
| 90636 |
|
12 |
12 |
$0.00 |