| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
117 |
112 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
67 |
66 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
131 |
131 |
$4K |
| 92015 |
Determination of refractive state |
443 |
429 |
$4K |
| V2025 |
Deluxe frame |
53 |
53 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
136 |
135 |
$607.98 |
| V2020 |
Frames, purchases |
12 |
12 |
$335.00 |
| 1036F |
|
14 |
13 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
14 |
13 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
15 |
12 |
$0.00 |
| 99199 |
Unlisted special service, procedure or report |
13 |
13 |
$0.00 |