| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,664 |
5,449 |
$224K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
3,380 |
3,302 |
$196K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
1,507 |
1,374 |
$116K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,025 |
970 |
$102K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,518 |
3,414 |
$95K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,148 |
1,046 |
$65K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
954 |
938 |
$53K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
333 |
314 |
$45K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
365 |
344 |
$42K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,253 |
1,167 |
$34K |
| 92015 |
Determination of refractive state |
2,039 |
1,940 |
$31K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
887 |
854 |
$22K |
| 92250 |
|
303 |
295 |
$20K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
424 |
405 |
$16K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
157 |
144 |
$3K |
| V2025 |
Deluxe frame |
43 |
42 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
78 |
72 |
$1K |
| 92083 |
|
16 |
16 |
$915.91 |
| 92133 |
|
19 |
19 |
$737.32 |