| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,704 |
3,673 |
$112K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,425 |
3,389 |
$67K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
810 |
808 |
$55K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
625 |
619 |
$48K |
| 92015 |
Determination of refractive state |
2,787 |
2,750 |
$31K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,216 |
2,083 |
$28K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
386 |
385 |
$18K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
313 |
313 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
135 |
126 |
$7K |
| 92341 |
|
213 |
212 |
$5K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
45 |
45 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
24 |
24 |
$1K |
| 92002 |
|
18 |
17 |
$795.52 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
86 |
84 |
$782.50 |
| 92250 |
|
38 |
38 |
$667.11 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
38 |
$652.47 |
| 99202 |
Office or other outpatient visit for the evaluation and management of a new patient, straightforward |
12 |
12 |
$508.68 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
15 |
15 |
$489.76 |
| V2750 |
Anti-reflective coating, per lens |
27 |
27 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
70 |
70 |
$0.00 |