| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
8,979 |
7,405 |
$2.92M |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,709 |
1,633 |
$135K |
| V2020 |
Frames, purchases |
2,490 |
1,922 |
$62K |
| V2750 |
Anti-reflective coating, per lens |
755 |
369 |
$11K |
| V2744 |
Tint, photochromatic, per lens |
240 |
130 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,025 |
1,089 |
$2K |
| V2299 |
Specialty bifocal (by report) |
45 |
28 |
$2K |
| V2781 |
Progressive lens, per lens |
45 |
28 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,809 |
2,659 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
14 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
323 |
307 |
$877.87 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
23 |
12 |
$841.62 |
| V2760 |
Scratch resistant coating, per lens |
60 |
22 |
$580.00 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,146 |
1,049 |
$393.67 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
286 |
249 |
$369.41 |
| V2025 |
Deluxe frame |
14 |
14 |
$166.32 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
94 |
91 |
$40.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
468 |
417 |
$35.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
183 |
175 |
$0.00 |
| 92250 |
|
142 |
140 |
$0.00 |
| 90656 |
|
24 |
24 |
$0.00 |
| 92082 |
|
29 |
27 |
$0.00 |
| 96127 |
|
14 |
13 |
$0.00 |
| G0008 |
Administration of influenza virus vaccine |
12 |
12 |
$0.00 |
| 92015 |
Determination of refractive state |
3,472 |
3,307 |
$0.00 |
| 92133 |
|
167 |
156 |
$0.00 |
| 92134 |
|
42 |
40 |
$0.00 |