| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
2,653 |
2,645 |
$116K |
| 92004 |
|
1,543 |
1,539 |
$110K |
| 92014 |
|
1,142 |
1,125 |
$64K |
| 92060 |
|
1,555 |
1,549 |
$50K |
| 92083 |
|
865 |
865 |
$43K |
| V2020 |
Frames, purchases |
1,347 |
1,321 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
836 |
475 |
$10K |
| 76512 |
|
112 |
112 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
566 |
479 |
$4K |
| 92015 |
|
296 |
296 |
$3K |
| 68761 |
|
29 |
29 |
$3K |
| 92225 |
|
148 |
148 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
114 |
114 |
$3K |
| 68801 |
|
29 |
29 |
$1K |
| 92286 |
|
16 |
16 |
$1K |
| 92012 |
|
28 |
24 |
$1K |
| V2219 |
Bifocal seg width over 28 mm |
25 |
25 |
$990.00 |
| 92340 |
|
47 |
47 |
$634.50 |
| 92341 |
|
19 |
19 |
$342.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$238.05 |
| 76514 |
|
13 |
13 |
$94.08 |
| G8785 |
Blood pressure reading not documented, reason not given |
14 |
14 |
$0.00 |
| G9905 |
Patient not screened for tobacco use |
104 |
102 |
$0.00 |