| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
590 |
575 |
$20K |
| 92015 |
Determination of refractive state |
1,925 |
1,686 |
$18K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
923 |
899 |
$7K |
| V2020 |
Frames, purchases |
317 |
284 |
$7K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
82 |
81 |
$4K |
| 76512 |
|
109 |
61 |
$1K |
| 92060 |
|
41 |
39 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
52 |
40 |
$704.53 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
14 |
12 |
$354.56 |
| 92134 |
|
73 |
68 |
$349.38 |
| 92275 |
|
93 |
55 |
$311.25 |
| 92225 |
|
268 |
142 |
$276.16 |
| 68761 |
|
33 |
24 |
$171.21 |
| 92285 |
|
15 |
15 |
$28.47 |
| 92202 |
|
13 |
12 |
$0.00 |
| 2022F |
|
34 |
34 |
$0.00 |
| G9744 |
Patient not eligible due to active diagnosis of hypertension |
55 |
54 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
28 |
28 |
$0.00 |
| 1036F |
|
13 |
13 |
$0.00 |