| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,142 |
1,118 |
$47K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,564 |
596 |
$43K |
| V2020 |
Frames, purchases |
880 |
674 |
$29K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
418 |
416 |
$17K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
214 |
214 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,392 |
523 |
$3K |
| V2750 |
Anti-reflective coating, per lens |
61 |
29 |
$1K |
| 92015 |
Determination of refractive state |
489 |
484 |
$764.90 |