| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,143 |
1,183 |
$53K |
| 92015 |
Determination of refractive state |
2,275 |
2,185 |
$53K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,053 |
1,018 |
$52K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,164 |
1,127 |
$44K |
| V2020 |
Frames, purchases |
2,292 |
2,194 |
$42K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,819 |
1,730 |
$31K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
1,760 |
837 |
$16K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
124 |
120 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
151 |
146 |
$7K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
98 |
98 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
113 |
110 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
28 |
28 |
$2K |
| 92341 |
|
26 |
26 |
$512.08 |
| 92250 |
|
13 |
13 |
$396.42 |