| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
7,862 |
7,858 |
$695K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
10,245 |
10,105 |
$677K |
| V2020 |
Frames, purchases |
18,256 |
18,196 |
$497K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
7,518 |
7,506 |
$475K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
20,504 |
20,394 |
$399K |
| 92015 |
Determination of refractive state |
27,852 |
27,767 |
$306K |
| 92250 |
|
14,047 |
14,014 |
$293K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
4,433 |
4,314 |
$204K |
| 92083 |
|
4,379 |
4,351 |
$138K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
11,772 |
8,210 |
$124K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
7,180 |
6,443 |
$119K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,567 |
1,567 |
$97K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,818 |
1,777 |
$86K |
| 92341 |
|
3,811 |
3,794 |
$85K |
| 92133 |
|
2,790 |
2,778 |
$50K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,056 |
1,055 |
$50K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
11,393 |
11,345 |
$27K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,642 |
1,814 |
$25K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
499 |
499 |
$25K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,967 |
1,548 |
$22K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
707 |
652 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
163 |
161 |
$13K |
| 92342 |
|
319 |
317 |
$8K |
| V2781 |
Progressive lens, per lens |
587 |
456 |
$6K |
| 99215 |
Prolong outpt/office vis |
28 |
28 |
$3K |
| 76514 |
|
434 |
433 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
252 |
179 |
$2K |
| 92134 |
|
106 |
106 |
$2K |
| V2025 |
Deluxe frame |
69 |
69 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
408 |
407 |
$847.40 |
| V2750 |
Anti-reflective coating, per lens |
1,159 |
1,150 |
$27.48 |
| 2023F |
|
566 |
562 |
$0.00 |
| 99072 |
|
308 |
305 |
$0.00 |