| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
525 |
491 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
220 |
217 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
110 |
105 |
$8K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
137 |
136 |
$5K |
| 96110 |
Developmental screening, with scoring and documentation, per standardized instrument |
129 |
128 |
$4K |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), 1 vaccine |
169 |
169 |
$3K |
| 92015 |
Determination of refractive state |
587 |
566 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
133 |
116 |
$3K |
| 76820 |
|
33 |
27 |
$2K |
| 92551 |
|
108 |
107 |
$1K |
| 90837 |
Psychotherapy, 53 minutes with patient |
15 |
12 |
$1K |
| 90472 |
Immunization administration, each additional vaccine (list separately) |
30 |
30 |
$1K |
| 99460 |
|
13 |
12 |
$833.25 |
| V2760 |
Scratch resistant coating, per lens |
112 |
108 |
$798.90 |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
12 |
12 |
$797.40 |
| 99173 |
|
129 |
128 |
$626.20 |
| 71045 |
Radiologic examination, chest; single view |
187 |
139 |
$603.37 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
56 |
49 |
$503.55 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
84 |
83 |
$409.75 |
| 71046 |
Radiologic examination, chest; 2 views |
47 |
45 |
$200.10 |
| 74018 |
|
24 |
16 |
$85.07 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
18 |
16 |
$40.82 |
| 90686 |
|
44 |
44 |
$0.00 |