| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,951 |
2,911 |
$287K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,740 |
1,721 |
$194K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,531 |
2,408 |
$148K |
| V2020 |
Frames, purchases |
2,883 |
2,881 |
$141K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,207 |
1,166 |
$101K |
| 92250 |
|
2,697 |
2,641 |
$95K |
| 92015 |
Determination of refractive state |
5,086 |
4,997 |
$82K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
239 |
239 |
$12K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
61 |
60 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
127 |
116 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,185 |
1,181 |
$6K |
| V2760 |
Scratch resistant coating, per lens |
450 |
450 |
$4K |
| 92133 |
|
99 |
98 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
52 |
52 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
41 |
41 |
$2K |
| V2025 |
Deluxe frame |
14 |
14 |
$910.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$658.50 |
| 92083 |
|
12 |
12 |
$546.32 |