| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,801 |
1,652 |
$129K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,025 |
1,961 |
$83K |
| V2020 |
Frames, purchases |
2,616 |
1,819 |
$78K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,332 |
1,300 |
$54K |
| V2750 |
Anti-reflective coating, per lens |
1,768 |
739 |
$33K |
| 92250 |
|
632 |
616 |
$33K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
596 |
560 |
$26K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,838 |
1,658 |
$11K |
| 92083 |
|
61 |
54 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
43 |
43 |
$2K |
| 92133 |
|
31 |
28 |
$1K |
| 92020 |
|
13 |
12 |
$227.00 |
| 92015 |
Determination of refractive state |
331 |
303 |
$40.00 |
| 2022F |
|
73 |
58 |
$0.00 |