| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
168 |
168 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
35 |
35 |
$4K |
| V2020 |
Frames, purchases |
180 |
173 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
125 |
71 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
46 |
29 |
$621.69 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
222 |
108 |
$460.00 |
| 92015 |
Determination of refractive state |
240 |
240 |
$31.78 |
| G9905 |
Patient not screened for tobacco use |
156 |
155 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
106 |
106 |
$0.00 |
| 1036F |
|
106 |
106 |
$0.00 |