| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
5,083 |
4,875 |
$373K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,676 |
2,592 |
$254K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
8,532 |
6,339 |
$238K |
| V2025 |
Deluxe frame |
5,250 |
5,052 |
$185K |
| V2020 |
Frames, purchases |
6,350 |
5,988 |
$172K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,395 |
2,330 |
$135K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,070 |
2,035 |
$119K |
| 92015 |
Determination of refractive state |
7,696 |
7,428 |
$99K |
| V2750 |
Anti-reflective coating, per lens |
1,491 |
1,414 |
$75K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
1,428 |
1,351 |
$65K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,610 |
1,191 |
$33K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
861 |
811 |
$12K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
561 |
451 |
$12K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
400 |
326 |
$10K |
| V2760 |
Scratch resistant coating, per lens |
372 |
353 |
$8K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
338 |
266 |
$7K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
103 |
93 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
54 |
53 |
$3K |
| 92060 |
|
67 |
65 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
41 |
36 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
18 |
16 |
$892.45 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
20 |
16 |
$410.06 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14 |
12 |
$367.53 |
| 1036F |
|
1,595 |
1,512 |
$0.00 |
| G9905 |
Patient not screened for tobacco use |
1,798 |
1,674 |
$0.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
30 |
27 |
$0.00 |
| G8785 |
Blood pressure reading not documented, reason not given |
14 |
14 |
$0.00 |