| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
6,980 |
6,973 |
$65K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,900 |
1,731 |
$56K |
| V2020 |
Frames, purchases |
8,196 |
8,154 |
$25K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,668 |
2,663 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,795 |
3,980 |
$20K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
7,409 |
4,013 |
$8K |
| 92015 |
Determination of refractive state |
2,298 |
2,294 |
$7K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
932 |
579 |
$5K |
| 92083 |
|
164 |
162 |
$3K |
| 92133 |
|
47 |
47 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
30 |
30 |
$900.00 |
| 92250 |
|
42 |
42 |
$760.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
12 |
$429.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
168 |
85 |
$102.60 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,157 |
1,666 |
$36.00 |
| V2744 |
Tint, photochromatic, per lens |
884 |
439 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
104 |
52 |
$0.00 |
| 2033F |
|
769 |
751 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
133 |
133 |
$0.00 |
| V2781 |
Progressive lens, per lens |
75 |
38 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
28 |
14 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
3,956 |
2,005 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
4,075 |
2,069 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
457 |
230 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
152 |
152 |
$0.00 |