| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| J0178 |
Injection, aflibercept, 1 mg |
1,008 |
734 |
$818K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,786 |
2,322 |
$110K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,915 |
1,868 |
$106K |
| 67028 |
Intravitreal injection of a pharmacologic agent |
3,183 |
2,287 |
$104K |
| V2020 |
Frames, purchases |
3,356 |
3,162 |
$79K |
| 92134 |
|
4,741 |
3,686 |
$68K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,112 |
1,065 |
$53K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,675 |
1,340 |
$52K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
823 |
728 |
$51K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
713 |
602 |
$34K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
491 |
442 |
$27K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
657 |
536 |
$21K |
| 92083 |
|
386 |
327 |
$16K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
262 |
243 |
$16K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
196 |
192 |
$14K |
| J9035 |
Injection, bevacizumab, 10 mg |
722 |
498 |
$11K |
| 92133 |
|
356 |
290 |
$9K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
120 |
102 |
$6K |
| 92015 |
Determination of refractive state |
299 |
274 |
$5K |
| V2025 |
Deluxe frame |
144 |
144 |
$2K |
| 92020 |
|
56 |
40 |
$777.82 |
| 92326 |
|
12 |
12 |
$720.00 |
| 76514 |
|
18 |
12 |
$121.44 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
12 |
$37.16 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$0.00 |