| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,049 |
990 |
$36K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
413 |
403 |
$32K |
| 92015 |
Determination of refractive state |
592 |
557 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
378 |
353 |
$14K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
237 |
217 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
219 |
217 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
209 |
197 |
$7K |
| 92370 |
|
592 |
549 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
93 |
89 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
419 |
391 |
$6K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
237 |
215 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
81 |
72 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
45 |
41 |
$2K |
| S0500 |
Disposable contact lens, per lens |
13 |
13 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
37 |
37 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
13 |
$705.38 |
| V2756 |
Eye glass case |
15 |
15 |
$65.00 |