| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
214 |
212 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
220 |
220 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
75 |
73 |
$4K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
42 |
42 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
66 |
65 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
112 |
111 |
$672.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
15 |
$266.02 |
| 92015 |
Determination of refractive state |
142 |
140 |
$87.90 |
| 1036F |
|
114 |
114 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
12 |
12 |
$0.00 |
| G8785 |
Blood pressure reading not documented, reason not given |
14 |
14 |
$0.00 |