| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,879 |
1,879 |
$38K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
682 |
682 |
$15K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
504 |
504 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
241 |
241 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
903 |
903 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
187 |
187 |
$9K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
287 |
287 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
631 |
631 |
$6K |
| 92341 |
|
309 |
309 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
638 |
638 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
254 |
254 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
31 |
31 |
$1K |
| 92250 |
|
43 |
43 |
$855.44 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
25 |
25 |
$750.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
62 |
62 |
$654.75 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15 |
15 |
$459.80 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
34 |
34 |
$341.25 |