| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
17,699 |
17,088 |
$733K |
| V2020 |
Frames, purchases |
21,353 |
20,432 |
$386K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
19,683 |
18,821 |
$335K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
7,774 |
7,527 |
$317K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
18,084 |
17,390 |
$197K |
| V2025 |
Deluxe frame |
5,498 |
5,390 |
$178K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
3,037 |
2,897 |
$44K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,626 |
1,555 |
$21K |
| 92015 |
Determination of refractive state |
33,599 |
31,891 |
$8K |
| V2750 |
Anti-reflective coating, per lens |
895 |
863 |
$6K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
128 |
121 |
$4K |
| V2799 |
Vision item or service, miscellaneous |
417 |
389 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
619 |
544 |
$3K |
| 92250 |
|
308 |
305 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
172 |
166 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
268 |
265 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
67 |
66 |
$918.84 |
| V2755 |
U-v lens, per lens |
37 |
37 |
$308.78 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
158 |
149 |
$305.31 |
| V2744 |
Tint, photochromatic, per lens |
63 |
63 |
$181.86 |
| V2760 |
Scratch resistant coating, per lens |
215 |
215 |
$41.56 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
1,647 |
1,514 |
$0.00 |
| 92002 |
|
13 |
13 |
$0.00 |