| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
195 |
193 |
$8K |
| V2025 |
Deluxe frame |
151 |
151 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
138 |
138 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
90 |
83 |
$3K |
| V2760 |
Scratch resistant coating, per lens |
127 |
127 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
27 |
27 |
$1K |
| V2755 |
U-v lens, per lens |
66 |
66 |
$787.50 |
| 92250 |
|
13 |
13 |
$166.07 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
159 |
157 |
$0.00 |
| 1036F |
|
187 |
175 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
332 |
313 |
$0.00 |