| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,789 |
2,727 |
$140K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
3,934 |
3,890 |
$122K |
| V2020 |
Frames, purchases |
6,482 |
6,313 |
$122K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,890 |
1,862 |
$111K |
| V2025 |
Deluxe frame |
1,490 |
1,474 |
$84K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,306 |
3,208 |
$70K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,019 |
2,945 |
$64K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
886 |
872 |
$45K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
794 |
788 |
$32K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
356 |
356 |
$28K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
860 |
854 |
$26K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,141 |
1,105 |
$24K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
2,280 |
2,098 |
$21K |
| 92134 |
|
1,923 |
1,889 |
$19K |
| 92133 |
|
1,530 |
1,509 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
618 |
605 |
$13K |
| 92250 |
|
385 |
384 |
$5K |
| 92020 |
|
275 |
275 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
39 |
39 |
$1K |
| 92225 |
|
17 |
17 |
$127.75 |
| 3072F |
|
35 |
25 |
$0.21 |
| 2027F |
|
17 |
17 |
$0.00 |
| 3284F |
|
15 |
15 |
$0.00 |