| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99305 |
|
4,391 |
4,386 |
$279K |
| 99306 |
Prolong nursin fac eval 15m |
2,678 |
2,675 |
$219K |
| 99309 |
Subsequent nursing facility care, per day, low to moderate complexity |
3,098 |
3,091 |
$176K |
| T2002 |
Non-emergency transportation; per diem |
12,185 |
11,696 |
$114K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,437 |
1,262 |
$69K |
| 92015 |
Determination of refractive state |
10,735 |
10,694 |
$28K |
| 99310 |
Prolong nursin fac eval 15m |
313 |
313 |
$18K |
| 92341 |
|
176 |
174 |
$5K |
| V2020 |
Frames, purchases |
177 |
120 |
$804.77 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
183 |
129 |
$468.02 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
35 |
26 |
$448.76 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
316 |
290 |
$396.90 |
| 93015 |
|
24 |
24 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
57 |
57 |
$0.00 |