| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
11,633 |
5,542 |
$411K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,239 |
3,852 |
$368K |
| V2020 |
Frames, purchases |
9,281 |
8,345 |
$317K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
10,044 |
4,851 |
$283K |
| V2755 |
U-v lens, per lens |
15,960 |
8,488 |
$196K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,682 |
1,547 |
$181K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
2,109 |
1,843 |
$175K |
| 92285 |
|
10,077 |
4,546 |
$133K |
| 92015 |
Determination of refractive state |
7,122 |
6,542 |
$103K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
4,261 |
3,960 |
$76K |
| 92083 |
|
950 |
457 |
$33K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
908 |
450 |
$27K |
| 92226 |
|
1,564 |
725 |
$27K |
| 92225 |
|
787 |
355 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
104 |
66 |
$3K |
| 92202 |
|
326 |
58 |
$3K |
| 76514 |
|
106 |
100 |
$963.59 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
13 |
$675.87 |
| 99072 |
|
365 |
320 |
$0.00 |