| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
100 |
93 |
$8K |
| V2020 |
Frames, purchases |
425 |
399 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
230 |
212 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
260 |
257 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
28 |
27 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
12 |
$757.46 |
| 92015 |
Determination of refractive state |
27 |
26 |
$475.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
15 |
$289.50 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
14 |
13 |
$177.90 |