| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
558 |
546 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
326 |
316 |
$27K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
859 |
836 |
$26K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
267 |
260 |
$26K |
| V2020 |
Frames, purchases |
1,085 |
1,055 |
$26K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
175 |
149 |
$5K |
| 92015 |
Determination of refractive state |
893 |
868 |
$4K |
| 92250 |
|
65 |
63 |
$3K |
| 92060 |
|
24 |
23 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
18 |
16 |
$878.24 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$380.74 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$375.20 |
| G8732 |
No documentation of pain assessment, reason not given |
136 |
115 |
$0.00 |
| G8428 |
Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given |
149 |
127 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
18 |
13 |
$0.00 |