| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
983 |
977 |
$78K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
736 |
735 |
$61K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
517 |
499 |
$50K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,516 |
2,413 |
$44K |
| 92250 |
|
739 |
724 |
$42K |
| V2025 |
Deluxe frame |
933 |
927 |
$39K |
| V2020 |
Frames, purchases |
1,737 |
1,659 |
$29K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,487 |
1,445 |
$26K |
| 92015 |
Determination of refractive state |
655 |
634 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
241 |
227 |
$9K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
510 |
485 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
440 |
425 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
44 |
43 |
$510.55 |