| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,518 |
3,507 |
$240K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,154 |
3,140 |
$177K |
| 92250 |
|
2,311 |
2,306 |
$105K |
| 92083 |
|
1,154 |
1,146 |
$57K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,378 |
1,874 |
$54K |
| V2020 |
Frames, purchases |
3,767 |
3,719 |
$52K |
| 68761 |
|
645 |
330 |
$43K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,048 |
973 |
$39K |
| 92133 |
|
864 |
864 |
$25K |
| 92285 |
|
668 |
655 |
$17K |
| 76512 |
|
234 |
124 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
115 |
113 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
67 |
67 |
$4K |
| 92015 |
Determination of refractive state |
265 |
265 |
$3K |
| 92002 |
|
63 |
63 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
107 |
53 |
$2K |
| 92225 |
|
85 |
46 |
$1K |
| 92060 |
|
28 |
28 |
$654.34 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
29 |
29 |
$652.77 |
| 76514 |
|
88 |
88 |
$646.49 |
| 92202 |
|
36 |
27 |
$560.88 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,920 |
976 |
$438.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
85 |
43 |
$375.22 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
26 |
26 |
$352.96 |
| 92020 |
|
21 |
20 |
$180.12 |
| 92286 |
|
31 |
30 |
$117.53 |
| 92025 |
|
37 |
37 |
$28.25 |
| V2755 |
U-v lens, per lens |
122 |
61 |
$0.00 |