| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,461 |
1,288 |
$34K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
697 |
641 |
$24K |
| 92250 |
|
598 |
595 |
$14K |
| 92133 |
|
426 |
412 |
$8K |
| 92083 |
|
453 |
437 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,045 |
4,028 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,652 |
2,632 |
$4K |
| 92015 |
Determination of refractive state |
3,604 |
3,562 |
$1K |
| V2020 |
Frames, purchases |
5,603 |
5,576 |
$192.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
892 |
533 |
$148.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,245 |
2,959 |
$130.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,958 |
2,221 |
$93.50 |
| V2760 |
Scratch resistant coating, per lens |
882 |
464 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
81 |
81 |
$0.00 |
| 2022F |
|
172 |
160 |
$0.00 |
| V2204 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$0.00 |
| 92341 |
|
13 |
13 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
107 |
64 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,051 |
606 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
90 |
50 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
743 |
395 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
66 |
66 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
31 |
28 |
$0.00 |
| V2781 |
Progressive lens, per lens |
86 |
52 |
$0.00 |