| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
812 |
783 |
$65K |
| V2020 |
Frames, purchases |
1,253 |
1,203 |
$31K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
516 |
499 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
432 |
422 |
$11K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
121 |
120 |
$9K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
180 |
146 |
$9K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
148 |
147 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
101 |
101 |
$7K |
| 92250 |
|
123 |
118 |
$6K |
| 92083 |
|
167 |
161 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
750 |
721 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
26 |
24 |
$2K |
| V2756 |
Eye glass case |
1,163 |
1,127 |
$1K |
| 92002 |
|
15 |
14 |
$788.54 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
19 |
16 |
$554.10 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
14 |
14 |
$517.16 |
| 92081 |
|
281 |
268 |
$469.70 |
| 92015 |
Determination of refractive state |
510 |
501 |
$60.20 |
| 92285 |
|
40 |
38 |
$0.00 |