| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,133 |
2,062 |
$144K |
| V2020 |
Frames, purchases |
3,189 |
3,042 |
$121K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
910 |
860 |
$92K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
930 |
835 |
$91K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,118 |
2,037 |
$64K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
667 |
654 |
$44K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
607 |
523 |
$31K |
| 92250 |
|
447 |
435 |
$30K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
930 |
874 |
$29K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
218 |
206 |
$26K |
| 92015 |
Determination of refractive state |
1,632 |
1,544 |
$25K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
104 |
100 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
401 |
383 |
$11K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
365 |
351 |
$9K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
118 |
104 |
$3K |
| 92083 |
|
26 |
26 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
14 |
14 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16 |
14 |
$586.60 |
| 92133 |
|
14 |
14 |
$546.93 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$198.00 |