| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
796 |
794 |
$48K |
| V2020 |
Frames, purchases |
2,027 |
1,961 |
$42K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
928 |
908 |
$23K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
289 |
287 |
$17K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
242 |
240 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
76 |
75 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
26 |
26 |
$730.28 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
89 |
88 |
$541.73 |
| 92015 |
Determination of refractive state |
48 |
48 |
$511.28 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$200.00 |
| 1123F |
|
102 |
101 |
$0.00 |
| 1036F |
|
156 |
155 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
237 |
234 |
$0.00 |
| G8482 |
Influenza immunization administered or previously received |
68 |
68 |
$0.00 |
| G8783 |
Normal blood pressure reading documented, follow-up not required |
80 |
79 |
$0.00 |
| G8442 |
Pain assessment not documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool at the time of the encounter |
12 |
12 |
$0.00 |
| G8484 |
Influenza immunization was not administered, reason not given |
12 |
12 |
$0.00 |
| 4040F |
|
59 |
59 |
$0.00 |