| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
5,137 |
5,116 |
$246K |
| 92250 |
|
4,267 |
4,253 |
$195K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
10,218 |
5,165 |
$149K |
| V2020 |
Frames, purchases |
12,590 |
12,483 |
$146K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,773 |
2,764 |
$141K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
2,557 |
1,277 |
$49K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,769 |
3,039 |
$32K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,041 |
2,036 |
$27K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
9,061 |
4,782 |
$26K |
| 92015 |
Determination of refractive state |
1,129 |
1,128 |
$13K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,154 |
693 |
$12K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
656 |
653 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
144 |
141 |
$7K |
| 92285 |
|
217 |
211 |
$6K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
12 |
12 |
$4K |
| 92341 |
|
86 |
85 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
240 |
120 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28 |
27 |
$932.59 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
27 |
25 |
$372.60 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
14 |
14 |
$320.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
29 |
15 |
$190.07 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$40.00 |
| V2755 |
U-v lens, per lens |
2,138 |
1,066 |
$0.00 |
| 2022F |
|
42 |
42 |
$0.00 |