| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,068 |
2,899 |
$170K |
| V2020 |
Frames, purchases |
1,931 |
1,925 |
$117K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,964 |
1,896 |
$109K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
684 |
676 |
$38K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
641 |
641 |
$23K |
| 92015 |
Determination of refractive state |
1,772 |
1,675 |
$10K |
| V2025 |
Deluxe frame |
196 |
196 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
678 |
677 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
31 |
29 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
16 |
$957.50 |
| 92250 |
|
27 |
24 |
$879.10 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
32 |
27 |
$720.01 |
| V2760 |
Scratch resistant coating, per lens |
36 |
36 |
$252.28 |