| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 68761 |
|
3,250 |
1,653 |
$151K |
| 76512 |
|
2,907 |
1,554 |
$124K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
4,269 |
3,578 |
$124K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,147 |
2,133 |
$111K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
885 |
880 |
$65K |
| 92083 |
|
1,742 |
1,729 |
$64K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
685 |
679 |
$47K |
| 92250 |
|
1,329 |
1,325 |
$46K |
| 92133 |
|
1,338 |
1,330 |
$29K |
| V2020 |
Frames, purchases |
1,747 |
1,706 |
$27K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,207 |
789 |
$20K |
| 92020 |
|
1,628 |
1,617 |
$18K |
| 92202 |
|
1,267 |
1,259 |
$17K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
369 |
320 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
388 |
367 |
$5K |
| 92015 |
Determination of refractive state |
384 |
374 |
$4K |
| 92226 |
|
113 |
107 |
$2K |
| 92285 |
|
39 |
39 |
$2K |
| 92225 |
|
76 |
73 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
108 |
106 |
$2K |
| 92145 |
|
208 |
151 |
$1K |
| 92134 |
|
40 |
40 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
56 |
54 |
$1K |
| 92273 |
|
15 |
14 |
$721.19 |
| 92283 |
|
69 |
67 |
$630.70 |
| 92341 |
|
26 |
24 |
$498.00 |
| 76514 |
|
65 |
65 |
$381.94 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
13 |
13 |
$108.00 |
| 2022F |
|
82 |
81 |
$0.00 |
| 99072 |
|
119 |
93 |
$0.00 |