| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,024 |
1,983 |
$60K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,005 |
1,961 |
$39K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
612 |
595 |
$30K |
| 92015 |
Determination of refractive state |
2,255 |
2,223 |
$24K |
| 92250 |
|
721 |
708 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,061 |
1,034 |
$17K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
157 |
155 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
105 |
104 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
88 |
88 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
86 |
83 |
$4K |
| 92002 |
|
81 |
81 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
44 |
43 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
33 |
31 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
46 |
46 |
$2K |
| 92341 |
|
62 |
61 |
$1K |
| 92083 |
|
12 |
12 |
$430.32 |
| 92285 |
|
32 |
27 |
$390.77 |
| 92133 |
|
13 |
12 |
$232.56 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
14 |
$191.82 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
81 |
81 |
$0.00 |