| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S9083 |
Global fee urgent care centers |
162 |
160 |
$25K |
| H0031 |
Mental health assessment, by non-physician |
61 |
51 |
$3K |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
48 |
47 |
$2K |
| T1015 |
Clinic visit/encounter, all-inclusive |
69 |
66 |
$2K |
| H0032 |
Mental health service plan development by non-physician |
50 |
50 |
$2K |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
144 |
85 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
38 |
37 |
$516.87 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
42 |
39 |
$444.07 |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
174 |
166 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
29 |
29 |
$0.00 |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
63 |
59 |
$0.00 |
| 71045 |
Radiologic examination, chest; single view |
73 |
58 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
101 |
101 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
72 |
66 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
145 |
144 |
$0.00 |
| V2020 |
Frames, purchases |
95 |
94 |
$0.00 |
| 93010 |
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only |
26 |
25 |
$0.00 |
| V2025 |
Deluxe frame |
73 |
73 |
$0.00 |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
17 |
17 |
$0.00 |
| 70450 |
Computed tomography, head or brain; without contrast material |
12 |
12 |
$0.00 |
| 90461 |
|
12 |
12 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
102 |
102 |
$0.00 |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
160 |
156 |
$0.00 |
| H0046 |
Mental health services, not otherwise specified |
14 |
12 |
$0.00 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
26 |
26 |
$0.00 |
| 74177 |
Computed tomography, abdomen and pelvis; with contrast material |
14 |
14 |
$0.00 |