| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
12,399 |
11,244 |
$611K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
7,432 |
6,648 |
$338K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
3,604 |
3,567 |
$337K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,837 |
2,808 |
$266K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,599 |
2,476 |
$228K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,649 |
1,549 |
$170K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,719 |
1,566 |
$79K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,621 |
1,443 |
$74K |
| 92015 |
Determination of refractive state |
5,059 |
4,780 |
$68K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
610 |
565 |
$20K |
| 92133 |
|
476 |
453 |
$16K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
104 |
100 |
$5K |
| 92134 |
|
163 |
153 |
$5K |
| 92250 |
|
138 |
135 |
$5K |
| 92060 |
|
79 |
74 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
39 |
33 |
$2K |
| 92310 |
|
25 |
25 |
$1K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
14 |
13 |
$849.12 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
31 |
29 |
$817.20 |
| V2750 |
Anti-reflective coating, per lens |
29 |
29 |
$648.00 |
| 76514 |
|
43 |
40 |
$428.36 |
| V2025 |
Deluxe frame |
13 |
13 |
$12.00 |