| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
5,271 |
5,214 |
$27K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,875 |
4,847 |
$27K |
| V2020 |
Frames, purchases |
8,182 |
7,985 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12,487 |
6,634 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
8,425 |
4,499 |
$6K |
| 92015 |
Determination of refractive state |
7,111 |
7,036 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
45 |
45 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
110 |
108 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
454 |
295 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
2,180 |
1,081 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
25 |
25 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
636 |
323 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
67 |
67 |
$0.00 |
| V2781 |
Progressive lens, per lens |
28 |
14 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
28 |
14 |
$0.00 |