| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,175 |
1,167 |
$50K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,809 |
1,020 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
483 |
479 |
$21K |
| V2020 |
Frames, purchases |
1,353 |
1,337 |
$17K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
130 |
123 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
62 |
61 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
822 |
457 |
$958.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
13 |
$205.40 |
| 92015 |
Determination of refractive state |
61 |
61 |
$180.50 |
| V2755 |
U-v lens, per lens |
448 |
221 |
$0.00 |