| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
492 |
447 |
$31K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
373 |
342 |
$23K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
531 |
500 |
$13K |
| V2020 |
Frames, purchases |
585 |
537 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
75 |
73 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
26 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
13 |
13 |
$2K |
| 92015 |
Determination of refractive state |
1,091 |
1,019 |
$2K |
| 92250 |
|
63 |
54 |
$557.45 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
669 |
608 |
$226.00 |
| 92020 |
|
24 |
24 |
$73.60 |
| V2025 |
Deluxe frame |
183 |
158 |
$0.00 |