| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,297 |
1,214 |
$130K |
| 92250 |
|
1,681 |
1,542 |
$61K |
| 92273 |
|
695 |
637 |
$50K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
676 |
593 |
$32K |
| 92083 |
|
601 |
544 |
$24K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
576 |
571 |
$24K |
| 95004 |
Percutaneous tests with allergenic extracts, immediate type reaction |
173 |
170 |
$21K |
| 92015 |
Determination of refractive state |
1,510 |
1,409 |
$20K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
375 |
363 |
$20K |
| V2020 |
Frames, purchases |
1,206 |
1,099 |
$13K |
| 99344 |
|
282 |
259 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,279 |
669 |
$9K |
| 92133 |
|
367 |
342 |
$9K |
| 68761 |
|
62 |
55 |
$7K |
| 99349 |
|
117 |
113 |
$5K |
| 92020 |
|
309 |
284 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
426 |
238 |
$3K |
| 76514 |
|
464 |
429 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
18 |
17 |
$612.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
181 |
84 |
$594.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
92 |
54 |
$446.34 |
| 92285 |
|
120 |
115 |
$396.08 |
| 92286 |
|
27 |
26 |
$56.92 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
32 |
32 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
40 |
40 |
$0.00 |