| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,370 |
1,359 |
$62K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,355 |
1,066 |
$45K |
| 92015 |
Determination of refractive state |
1,876 |
1,856 |
$39K |
| V2020 |
Frames, purchases |
1,875 |
1,831 |
$32K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
504 |
496 |
$30K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,706 |
1,669 |
$30K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
455 |
384 |
$22K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
1,056 |
1,050 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
489 |
416 |
$16K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
195 |
133 |
$9K |
| 92250 |
|
145 |
142 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
72 |
71 |
$3K |
| 92341 |
|
134 |
131 |
$3K |
| 92133 |
|
26 |
26 |
$769.54 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
39 |
39 |
$608.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
15 |
12 |
$494.43 |