| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
6,580 |
6,072 |
$381K |
| V2020 |
Frames, purchases |
17,452 |
15,814 |
$348K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,044 |
3,576 |
$308K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,664 |
2,375 |
$249K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
8,283 |
7,900 |
$191K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,926 |
2,708 |
$160K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
5,499 |
4,405 |
$145K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
2,801 |
2,625 |
$58K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
4,310 |
3,245 |
$55K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,175 |
2,002 |
$52K |
| 92015 |
Determination of refractive state |
6,984 |
5,996 |
$35K |
| 92133 |
|
898 |
810 |
$28K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
786 |
725 |
$19K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
735 |
680 |
$17K |
| 92250 |
|
241 |
224 |
$13K |
| 92083 |
|
225 |
206 |
$12K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
290 |
262 |
$9K |
| V2744 |
Tint, photochromatic, per lens |
363 |
345 |
$7K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
176 |
172 |
$6K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
206 |
194 |
$5K |
| V2750 |
Anti-reflective coating, per lens |
252 |
231 |
$4K |
| 76514 |
|
233 |
209 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
76 |
72 |
$2K |
| 92060 |
|
18 |
17 |
$924.73 |
| V2025 |
Deluxe frame |
12 |
12 |
$469.64 |
| 92145 |
|
120 |
109 |
$12.50 |
| G8428 |
Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given |
15 |
12 |
$0.00 |