| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,256 |
1,237 |
$112K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,146 |
1,131 |
$73K |
| V2020 |
Frames, purchases |
2,400 |
2,304 |
$60K |
| 92065 |
|
1,982 |
685 |
$60K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
855 |
716 |
$54K |
| 92060 |
|
822 |
656 |
$39K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,701 |
1,334 |
$28K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
226 |
190 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
392 |
345 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
34 |
33 |
$2K |
| V2756 |
Eye glass case |
2,243 |
2,173 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
78 |
69 |
$1K |
| 97530 |
Therapeutic activities, direct patient contact, each 15 minutes |
51 |
16 |
$938.96 |
| 97110 |
Therapeutic procedure, each 15 minutes; therapeutic exercises to develop strength and endurance, flexibility and range of motion |
36 |
15 |
$628.72 |
| 92015 |
Determination of refractive state |
2,407 |
2,362 |
$518.95 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
19 |
18 |
$480.22 |
| 92370 |
|
25 |
25 |
$360.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
15 |
14 |
$0.00 |