| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,349 |
1,339 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,479 |
1,466 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
288 |
287 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,621 |
1,611 |
$0.00 |
| 92310 |
|
55 |
55 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
12 |
12 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
130 |
130 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
35 |
35 |
$0.00 |
| G8428 |
Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given |
38 |
38 |
$0.00 |
| 1036F |
|
35 |
35 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,341 |
2,309 |
$0.00 |
| 92015 |
Determination of refractive state |
2,699 |
2,654 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
579 |
574 |
$0.00 |
| V2020 |
Frames, purchases |
2,681 |
2,670 |
$0.00 |