| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,028 |
2,012 |
$97K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,798 |
1,795 |
$82K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,357 |
1,348 |
$81K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,230 |
3,219 |
$66K |
| V2020 |
Frames, purchases |
1,677 |
1,674 |
$51K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,136 |
1,074 |
$46K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
503 |
503 |
$30K |
| 92083 |
|
525 |
525 |
$19K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,183 |
1,178 |
$16K |
| 92250 |
|
436 |
436 |
$14K |
| 92341 |
|
337 |
337 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
478 |
475 |
$6K |
| 92133 |
|
116 |
116 |
$2K |
| 92020 |
|
86 |
86 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
61 |
61 |
$959.21 |
| 92015 |
Determination of refractive state |
80 |
80 |
$887.20 |
| 76514 |
|
67 |
67 |
$546.17 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
16 |
16 |
$239.78 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$193.25 |
| V2756 |
Eye glass case |
585 |
582 |
$132.57 |
| 2022F |
|
186 |
185 |
$0.00 |