| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
6,036 |
6,015 |
$277K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,117 |
3,110 |
$225K |
| 92083 |
|
3,161 |
3,143 |
$153K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,150 |
2,144 |
$126K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,752 |
2,378 |
$89K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
2,119 |
2,092 |
$81K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,147 |
1,033 |
$45K |
| V2020 |
Frames, purchases |
3,233 |
3,200 |
$33K |
| 92015 |
Determination of refractive state |
300 |
300 |
$9K |
| 92002 |
|
214 |
213 |
$8K |
| 92132 |
|
243 |
243 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
546 |
265 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,556 |
2,751 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
33 |
33 |
$2K |
| 76514 |
|
121 |
120 |
$976.55 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
62 |
62 |
$930.00 |
| V2755 |
U-v lens, per lens |
32 |
16 |
$0.00 |