| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
7,490 |
6,954 |
$358K |
| V2020 |
Frames, purchases |
2,244 |
2,077 |
$136K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,462 |
1,375 |
$98K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,023 |
1,701 |
$96K |
| 92015 |
Determination of refractive state |
9,660 |
8,582 |
$91K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,759 |
1,653 |
$47K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
346 |
304 |
$25K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
641 |
596 |
$24K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
619 |
532 |
$23K |
| 99072 |
|
824 |
755 |
$13K |
| 92134 |
|
521 |
485 |
$13K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
89 |
79 |
$6K |
| V2756 |
Eye glass case |
3,704 |
3,493 |
$6K |
| V2025 |
Deluxe frame |
1,095 |
1,087 |
$4K |
| 67028 |
Intravitreal injection of a pharmacologic agent |
21 |
13 |
$2K |
| 92136 |
|
20 |
12 |
$643.74 |
| 92310 |
|
27 |
25 |
$283.32 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
690 |
685 |
$210.99 |
| S9999 |
Sales tax |
1,034 |
886 |
$26.10 |
| V2750 |
Anti-reflective coating, per lens |
188 |
180 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
25 |
25 |
$0.00 |
| V2755 |
U-v lens, per lens |
44 |
44 |
$0.00 |