| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
4,584 |
4,505 |
$187K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,115 |
4,053 |
$161K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,496 |
2,430 |
$95K |
| V2020 |
Frames, purchases |
6,086 |
5,909 |
$93K |
| 92285 |
|
2,333 |
2,285 |
$83K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,962 |
1,849 |
$62K |
| 68761 |
|
827 |
388 |
$50K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,309 |
2,196 |
$43K |
| 92083 |
|
1,144 |
1,122 |
$40K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,397 |
2,237 |
$34K |
| 92133 |
|
1,229 |
1,209 |
$27K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,492 |
2,471 |
$21K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,256 |
2,080 |
$20K |
| V2219 |
Bifocal seg width over 28 mm |
634 |
620 |
$16K |
| 92225 |
|
350 |
220 |
$7K |
| 92286 |
|
144 |
141 |
$6K |
| 92341 |
|
502 |
498 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
154 |
139 |
$4K |
| 92202 |
|
345 |
216 |
$3K |
| 92060 |
|
88 |
88 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
41 |
41 |
$1K |
| 92025 |
|
66 |
64 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
24 |
24 |
$1K |
| 76514 |
|
265 |
258 |
$739.40 |
| 92015 |
Determination of refractive state |
63 |
63 |
$720.00 |
| 92134 |
|
38 |
37 |
$526.12 |
| 92201 |
|
30 |
29 |
$434.14 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$404.04 |
| 92020 |
|
27 |
27 |
$244.11 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
15 |
15 |
$201.50 |
| V2780 |
Oversize lens, per lens |
114 |
114 |
$35.00 |
| V2750 |
Anti-reflective coating, per lens |
74 |
52 |
$0.00 |
| 92132 |
|
12 |
12 |
$0.00 |