| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
6,908 |
6,440 |
$238K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,419 |
4,134 |
$192K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,815 |
2,631 |
$162K |
| 92134 |
|
4,165 |
3,848 |
$109K |
| V2020 |
Frames, purchases |
1,415 |
1,310 |
$103K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,591 |
1,755 |
$103K |
| 92284 |
|
2,040 |
1,838 |
$99K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,076 |
990 |
$48K |
| V2025 |
Deluxe frame |
4,846 |
4,617 |
$47K |
| 92015 |
Determination of refractive state |
11,731 |
8,151 |
$46K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,790 |
1,658 |
$43K |
| 68761 |
|
640 |
378 |
$41K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
432 |
426 |
$34K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,172 |
1,998 |
$30K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
431 |
271 |
$29K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
567 |
507 |
$17K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
144 |
143 |
$16K |
| V2756 |
Eye glass case |
2,674 |
2,455 |
$14K |
| 92273 |
|
173 |
157 |
$11K |
| 92341 |
|
247 |
226 |
$8K |
| 92083 |
|
214 |
200 |
$7K |
| 99072 |
|
249 |
223 |
$4K |
| 95930 |
|
100 |
85 |
$4K |
| 92081 |
|
317 |
303 |
$3K |
| 76513 |
|
45 |
25 |
$3K |
| 92133 |
|
116 |
107 |
$3K |
| 76514 |
|
190 |
180 |
$2K |
| 92310 |
|
80 |
68 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
511 |
463 |
$638.09 |
| 92283 |
|
12 |
12 |
$398.53 |
| 92132 |
|
31 |
29 |
$261.91 |
| V2744 |
Tint, photochromatic, per lens |
40 |
37 |
$78.49 |
| V2781 |
Progressive lens, per lens |
63 |
60 |
$57.59 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
12 |
12 |
$16.99 |
| V2755 |
U-v lens, per lens |
1,002 |
1,001 |
$0.00 |
| A4262 |
Temporary, absorbable lacrimal duct implant, each |
269 |
220 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,034 |
3,022 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
115 |
115 |
$0.00 |
| S9999 |
Sales tax |
1,295 |
1,206 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
1,029 |
1,022 |
$0.00 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
76 |
74 |
$0.00 |
| A4550 |
Surgical trays |
26 |
24 |
$0.00 |