| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,269 |
1,190 |
$84K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,038 |
988 |
$83K |
| V2020 |
Frames, purchases |
1,183 |
1,182 |
$62K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
850 |
834 |
$49K |
| 92015 |
Determination of refractive state |
2,070 |
1,739 |
$20K |
| 92250 |
|
290 |
265 |
$7K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
26 |
25 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
17 |
14 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13 |
13 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
24 |
24 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14 |
13 |
$827.41 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
111 |
111 |
$583.00 |