| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
1,020 |
1,007 |
$46K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,509 |
1,002 |
$24K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
911 |
890 |
$23K |
| 92082 |
|
497 |
491 |
$20K |
| V2020 |
Frames, purchases |
1,367 |
1,351 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
148 |
148 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
112 |
102 |
$4K |
| 92083 |
|
69 |
68 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
50 |
50 |
$3K |
| 92133 |
|
71 |
70 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
47 |
25 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
46 |
41 |
$1K |
| 92015 |
Determination of refractive state |
828 |
820 |
$597.20 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
681 |
351 |
$194.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
20 |
13 |
$137.50 |
| V2755 |
U-v lens, per lens |
256 |
127 |
$0.00 |