| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
2,612 |
2,594 |
$91K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,574 |
1,497 |
$64K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,156 |
1,149 |
$61K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
848 |
843 |
$36K |
| 92225 |
|
768 |
767 |
$32K |
| V2020 |
Frames, purchases |
2,480 |
2,466 |
$31K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,314 |
986 |
$28K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,711 |
1,617 |
$28K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
660 |
653 |
$26K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
467 |
465 |
$19K |
| 92015 |
Determination of refractive state |
2,906 |
2,896 |
$11K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
117 |
117 |
$7K |
| 92226 |
|
135 |
132 |
$4K |
| 92083 |
|
121 |
114 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
31 |
29 |
$624.00 |
| 92133 |
|
12 |
12 |
$265.74 |
| V2744 |
Tint, photochromatic, per lens |
118 |
59 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
544 |
291 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
675 |
355 |
$0.00 |