| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
2,719 |
2,651 |
$118K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,249 |
2,198 |
$106K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,704 |
1,673 |
$88K |
| V2020 |
Frames, purchases |
4,972 |
4,898 |
$59K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,077 |
2,461 |
$47K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,032 |
1,000 |
$42K |
| 92083 |
|
436 |
425 |
$22K |
| 92132 |
|
527 |
515 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,008 |
1,122 |
$12K |
| 92226 |
|
722 |
353 |
$9K |
| 92285 |
|
184 |
175 |
$9K |
| 92133 |
|
272 |
262 |
$8K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
398 |
268 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
765 |
396 |
$4K |
| 92225 |
|
237 |
119 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
82 |
82 |
$3K |
| 92134 |
|
58 |
57 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
80 |
80 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
102 |
102 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,516 |
821 |
$677.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
60 |
32 |
$326.48 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
45 |
24 |
$283.98 |
| 76514 |
|
38 |
37 |
$241.12 |
| 92202 |
|
14 |
13 |
$104.93 |
| V2755 |
U-v lens, per lens |
976 |
487 |
$0.00 |
| 92015 |
Determination of refractive state |
587 |
556 |
$0.00 |