| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
698 |
674 |
$47K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
169 |
168 |
$16K |
| V2020 |
Frames, purchases |
505 |
495 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
412 |
402 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
333 |
328 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
448 |
440 |
$5K |
| 92015 |
Determination of refractive state |
958 |
931 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28 |
26 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
37 |
$500.00 |