| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
3,399 |
3,317 |
$243K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,680 |
2,612 |
$192K |
| V2020 |
Frames, purchases |
7,014 |
6,520 |
$168K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
7,206 |
6,745 |
$143K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,883 |
4,553 |
$105K |
| 92250 |
|
2,358 |
2,264 |
$82K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
927 |
852 |
$56K |
| V2025 |
Deluxe frame |
1,181 |
1,164 |
$44K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,139 |
1,060 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,103 |
1,038 |
$23K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
645 |
581 |
$19K |
| 92015 |
Determination of refractive state |
1,563 |
1,446 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
82 |
70 |
$6K |
| V2750 |
Anti-reflective coating, per lens |
208 |
198 |
$6K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
206 |
182 |
$4K |
| 92310 |
|
28 |
26 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
14 |
13 |
$399.06 |
| V2755 |
U-v lens, per lens |
127 |
123 |
$169.71 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
230 |
213 |
$0.00 |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
27 |
27 |
$0.00 |