| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,051 |
1,035 |
$70K |
| V2750 |
Anti-reflective coating, per lens |
1,326 |
1,291 |
$46K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,509 |
1,472 |
$26K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,330 |
1,298 |
$19K |
| V2020 |
Frames, purchases |
1,322 |
1,290 |
$19K |
| 92015 |
Determination of refractive state |
1,530 |
1,510 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
538 |
528 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
46 |
46 |
$4K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
54 |
53 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
12 |
$504.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$298.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$0.17 |