| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,373 |
1,305 |
$117K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,824 |
1,759 |
$114K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,550 |
2,481 |
$94K |
| V2020 |
Frames, purchases |
2,722 |
2,481 |
$69K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
1,607 |
1,420 |
$57K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,323 |
1,212 |
$27K |
| 92015 |
Determination of refractive state |
1,027 |
973 |
$15K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
175 |
169 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,457 |
1,338 |
$9K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
99 |
89 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
235 |
223 |
$4K |
| V2760 |
Scratch resistant coating, per lens |
1,062 |
1,035 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16 |
12 |
$605.35 |
| 92134 |
|
17 |
15 |
$377.21 |
| S9999 |
Sales tax |
13 |
13 |
$17.64 |