| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
2,912 |
2,911 |
$83K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,543 |
1,530 |
$28K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
621 |
604 |
$16K |
| 92002 |
|
399 |
399 |
$14K |
| 92341 |
|
655 |
655 |
$12K |
| 92015 |
Determination of refractive state |
2,293 |
2,293 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,444 |
1,444 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,117 |
2,074 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,557 |
807 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
296 |
296 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,146 |
1,566 |
$532.20 |
| V2020 |
Frames, purchases |
3,433 |
3,304 |
$238.31 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
32 |
26 |
$21.00 |
| 2022F |
|
12 |
12 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
163 |
163 |
$0.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
28 |
12 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
145 |
78 |
$0.00 |
| 3072F |
|
154 |
154 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
29 |
29 |
$0.00 |