| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
824 |
667 |
$33K |
| V2760 |
Scratch resistant coating, per lens |
1,570 |
638 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,660 |
674 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
340 |
125 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
154 |
148 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
41 |
41 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
41 |
41 |
$2K |
| 92083 |
|
22 |
12 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
14 |
14 |
$1K |
| 92133 |
|
22 |
12 |
$773.44 |
| 92020 |
|
30 |
29 |
$581.50 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$425.25 |
| 92015 |
Determination of refractive state |
102 |
94 |
$40.00 |