| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,069 |
1,032 |
$63K |
| V2020 |
Frames, purchases |
1,769 |
1,668 |
$61K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
748 |
706 |
$21K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
171 |
158 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
481 |
448 |
$13K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
305 |
287 |
$9K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
131 |
129 |
$9K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
191 |
154 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
78 |
77 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
328 |
288 |
$7K |
| 92015 |
Determination of refractive state |
462 |
409 |
$5K |
| S0500 |
Disposable contact lens, per lens |
30 |
26 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
31 |
31 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$759.64 |
| 92133 |
|
13 |
13 |
$569.89 |