| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
3,356 |
3,332 |
$239K |
| V2020 |
Vision svcs frames purchases |
7,502 |
7,208 |
$205K |
| 92014 |
|
2,973 |
2,943 |
$172K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,401 |
1,257 |
$70K |
| V2100 |
Lens spher single plano 4.00 |
3,251 |
1,533 |
$69K |
| V2784 |
Lens polycarb or equal |
6,832 |
3,479 |
$29K |
| 92015 |
|
4,750 |
4,652 |
$15K |
| S0580 |
Polycarb lens |
253 |
253 |
$5K |
| V2200 |
Lens spher bifoc plano 4.00d |
100 |
50 |
$3K |
| 92012 |
|
48 |
47 |
$2K |
| 99214 |
|
44 |
43 |
$2K |
| S0621 |
Routine ophthalmological exa |
27 |
27 |
$2K |
| 99204 |
|
12 |
12 |
$1K |
| 92250 |
|
76 |
72 |
$1K |
| S0620 |
Routine ophthalmological exa |
13 |
13 |
$697.10 |
| 99213 |
|
15 |
13 |
$441.44 |
| G8785 |
Bp scrn no perf at interval |
119 |
119 |
$0.00 |
| G8427 |
Docrev cur meds by elig clin |
53 |
53 |
$0.00 |
| S9986 |
Not medically necessary svc |
13 |
13 |
$0.00 |
| G8732 |
No doc of pain |
105 |
105 |
$0.00 |
| G8428 |
Cur meds not document |
58 |
56 |
$0.00 |
| 1036F |
|
57 |
55 |
$0.00 |
| G9903 |
Pt scrn tbco id as non user |
12 |
12 |
$0.00 |