| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,927 |
1,879 |
$73K |
| 92250 |
|
1,274 |
1,139 |
$43K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,044 |
1,032 |
$40K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
516 |
505 |
$11K |
| V2020 |
Frames, purchases |
681 |
660 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
404 |
392 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$577.60 |
| 92015 |
Determination of refractive state |
3,098 |
3,028 |
$270.03 |
| V2025 |
Deluxe frame |
17 |
17 |
$187.00 |
| 92227 |
|
13 |
13 |
$55.66 |