| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,273 |
5,060 |
$282K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,728 |
2,623 |
$233K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,910 |
2,799 |
$183K |
| 92250 |
|
2,848 |
2,543 |
$88K |
| 92015 |
Determination of refractive state |
7,673 |
7,139 |
$55K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
949 |
842 |
$32K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
432 |
360 |
$30K |
| 92341 |
|
353 |
344 |
$17K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
337 |
298 |
$17K |
| V2020 |
Frames, purchases |
2,641 |
1,609 |
$8K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
105 |
98 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,138 |
690 |
$5K |
| S0516 |
Safety eyeglass frames |
154 |
154 |
$2K |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
154 |
154 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
104 |
53 |
$900.00 |
| 92370 |
|
32 |
32 |
$870.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
641 |
397 |
$756.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
27 |
24 |
$672.88 |
| S9999 |
Sales tax |
319 |
319 |
$497.76 |
| V2760 |
Scratch resistant coating, per lens |
13 |
13 |
$65.00 |
| G8732 |
No documentation of pain assessment, reason not given |
25 |
24 |
$0.00 |
| G8428 |
Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given |
40 |
38 |
$0.00 |