| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
2,699 |
2,691 |
$412K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,592 |
3,134 |
$220K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
7,873 |
6,513 |
$205K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,096 |
2,066 |
$105K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,236 |
1,222 |
$83K |
| 92015 |
Determination of refractive state |
5,319 |
5,270 |
$60K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,233 |
1,232 |
$44K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
929 |
860 |
$39K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
428 |
364 |
$37K |
| 92250 |
|
1,030 |
1,028 |
$34K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
529 |
526 |
$22K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
445 |
411 |
$19K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
183 |
180 |
$19K |
| 92341 |
|
209 |
208 |
$7K |
| V2020 |
Frames, purchases |
194 |
193 |
$4K |
| 92226 |
|
34 |
26 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
48 |
48 |
$840.61 |
| 80307 |
Drug test(s), presumptive, any number of drug classes; immunoassay |
12 |
12 |
$570.60 |
| V2781 |
Progressive lens, per lens |
12 |
12 |
$244.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
237 |
236 |
$130.60 |
| S0590 |
Integral lens service, miscellaneous services reported separately |
25 |
25 |
$0.00 |