| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
270 |
232 |
$14K |
| V2020 |
Frames, purchases |
71 |
71 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
53 |
51 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
58 |
58 |
$2K |
| 92015 |
Determination of refractive state |
151 |
121 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
17 |
13 |
$923.69 |
| 92250 |
|
16 |
14 |
$588.90 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$337.90 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
53 |
47 |
$208.02 |
| 1036F |
|
85 |
56 |
$113.40 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
83 |
55 |
$113.40 |