| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
11,292 |
10,877 |
$396K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
19,179 |
18,948 |
$198K |
| V2020 |
Frames, purchases |
23,650 |
23,444 |
$76K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
7,773 |
7,747 |
$72K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
27,754 |
15,181 |
$49K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,375 |
1,308 |
$43K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
21,084 |
11,234 |
$36K |
| 92015 |
Determination of refractive state |
6,242 |
6,111 |
$24K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
5,871 |
3,376 |
$20K |
| 92083 |
|
802 |
769 |
$13K |
| 92133 |
|
615 |
590 |
$11K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
341 |
307 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
211 |
211 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
61 |
58 |
$728.50 |
| 76514 |
|
67 |
64 |
$718.33 |
| V2300 |
Sphere, trifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$279.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
237 |
237 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
2,042 |
1,021 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
868 |
432 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,607 |
2,911 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
1,180 |
583 |
$0.00 |
| V2781 |
Progressive lens, per lens |
1,697 |
849 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,053 |
1,069 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
8,730 |
4,343 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
510 |
510 |
$0.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$0.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
24 |
12 |
$0.00 |