| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,020 |
1,002 |
$47K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
607 |
602 |
$16K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
144 |
133 |
$14K |
| V2020 |
Frames, purchases |
456 |
452 |
$9K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
107 |
106 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
169 |
169 |
$8K |
| V2025 |
Deluxe frame |
108 |
108 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
496 |
492 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
52 |
52 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
24 |
24 |
$1K |
| 92015 |
Determination of refractive state |
897 |
891 |
$886.14 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
13 |
$848.07 |