| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 68761 |
|
796 |
753 |
$62K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,138 |
1,036 |
$44K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
260 |
256 |
$13K |
| 92250 |
|
520 |
501 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
500 |
236 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
175 |
157 |
$9K |
| V2020 |
Frames, purchases |
455 |
433 |
$5K |
| 0507T |
|
177 |
176 |
$4K |
| 92083 |
|
135 |
129 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
58 |
56 |
$2K |
| 92133 |
|
136 |
136 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
30 |
15 |
$616.20 |
| 92134 |
|
38 |
38 |
$608.26 |
| 92285 |
|
67 |
65 |
$419.06 |
| 92015 |
Determination of refractive state |
13 |
12 |
$125.64 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
880 |
423 |
$0.00 |