| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,356 |
3,332 |
$239K |
| V2020 |
Frames, purchases |
7,502 |
7,208 |
$205K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,973 |
2,943 |
$172K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,401 |
1,257 |
$70K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,251 |
1,533 |
$69K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,832 |
3,479 |
$29K |
| 92015 |
Determination of refractive state |
4,750 |
4,652 |
$15K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
253 |
253 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
100 |
50 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
48 |
47 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
44 |
43 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
27 |
27 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$1K |
| 92250 |
|
76 |
72 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
13 |
13 |
$697.10 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15 |
13 |
$441.44 |
| G8785 |
Blood pressure reading not documented, reason not given |
119 |
119 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
53 |
53 |
$0.00 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
13 |
13 |
$0.00 |
| G8732 |
No documentation of pain assessment, reason not given |
105 |
105 |
$0.00 |
| G8428 |
Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given |
58 |
56 |
$0.00 |
| 1036F |
|
57 |
55 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
12 |
12 |
$0.00 |