| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
10,270 |
10,212 |
$332K |
| 99213 |
|
3,972 |
3,745 |
$154K |
| 92004 |
|
4,294 |
4,271 |
$138K |
| V2020 |
Vision svcs frames purchases |
8,573 |
8,558 |
$92K |
| V2784 |
Lens polycarb or equal |
6,285 |
4,746 |
$92K |
| V2100 |
Lens spher single plano 4.00 |
6,487 |
5,507 |
$85K |
| 92340 |
|
4,059 |
4,005 |
$74K |
| 92250 |
|
2,195 |
2,151 |
$56K |
| 92015 |
|
11,288 |
11,035 |
$45K |
| 92012 |
|
558 |
525 |
$28K |
| 92133 |
|
372 |
365 |
$6K |
| V2200 |
Lens spher bifoc plano 4.00d |
450 |
365 |
$6K |
| 92225 |
|
287 |
151 |
$6K |
| 92083 |
|
296 |
295 |
$4K |
| 68761 |
|
70 |
39 |
$2K |
| 92341 |
|
88 |
87 |
$2K |
| 92020 |
|
51 |
51 |
$636.80 |
| V2520 |
Contact lens hydrophilic |
13 |
13 |
$400.00 |
| 92202 |
|
24 |
24 |
$165.18 |
| 92201 |
|
15 |
12 |
$128.32 |
| G2012 |
Brief check in by md/qhp |
14 |
14 |
$37.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
20 |
12 |
$19.00 |
| S0621 |
Routine ophthalmological exa |
196 |
196 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
954 |
506 |
$0.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
54 |
27 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,241 |
1,188 |
$0.00 |
| 3072F |
|
6,813 |
6,347 |
$0.00 |
| V2781 |
Progressive lens per lens |
224 |
122 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
229 |
125 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
97 |
97 |
$0.00 |
| 1036F |
|
14 |
13 |
$0.00 |