| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,054 |
1,017 |
$64K |
| V2020 |
Frames, purchases |
2,907 |
2,776 |
$58K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,870 |
1,854 |
$41K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
398 |
393 |
$25K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,370 |
1,364 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
380 |
376 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
26 |
$3K |
| 92015 |
Determination of refractive state |
248 |
243 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
153 |
147 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$323.26 |
| G9905 |
Patient not screened for tobacco use |
43 |
41 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
273 |
258 |
$0.00 |