| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
4,905 |
4,888 |
$132K |
| 92226 |
|
1,798 |
1,733 |
$66K |
| 92225 |
|
888 |
792 |
$35K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
9,976 |
9,882 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
42 |
38 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
17 |
16 |
$915.75 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,420 |
4,217 |
$652.93 |
| 92134 |
|
27 |
27 |
$522.72 |
| 92083 |
|
16 |
16 |
$358.40 |
| 92133 |
|
15 |
15 |
$290.40 |
| 92202 |
|
41 |
41 |
$277.60 |
| 92020 |
|
15 |
15 |
$264.00 |
| 76514 |
|
15 |
15 |
$165.00 |
| V2744 |
Tint, photochromatic, per lens |
289 |
159 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,280 |
783 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
286 |
146 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,050 |
1,265 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
116 |
58 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
166 |
91 |
$0.00 |
| V2781 |
Progressive lens, per lens |
168 |
92 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
101 |
101 |
$0.00 |
| 92015 |
Determination of refractive state |
2,769 |
2,758 |
$0.00 |
| V2020 |
Frames, purchases |
1,923 |
1,906 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
871 |
551 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
723 |
723 |
$0.00 |
| 2022F |
|
52 |
44 |
$0.00 |