| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,721 |
2,648 |
$257K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
3,683 |
3,592 |
$251K |
| V2020 |
Frames, purchases |
7,421 |
7,201 |
$235K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,529 |
4,415 |
$128K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,591 |
1,529 |
$122K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,129 |
1,076 |
$122K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
1,556 |
1,492 |
$85K |
| 92250 |
|
1,487 |
1,427 |
$84K |
| 92015 |
Determination of refractive state |
6,500 |
6,245 |
$83K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,052 |
1,028 |
$68K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,608 |
1,557 |
$48K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,395 |
1,322 |
$47K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
606 |
588 |
$19K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
593 |
554 |
$13K |
| 92083 |
|
214 |
206 |
$10K |
| V2025 |
Deluxe frame |
165 |
162 |
$8K |
| 92133 |
|
202 |
195 |
$7K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
65 |
64 |
$2K |
| 76514 |
|
26 |
26 |
$197.26 |
| 1036F |
|
55 |
53 |
$0.00 |