| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,910 |
3,688 |
$427K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,701 |
4,435 |
$424K |
| 92015 |
Determination of refractive state |
9,087 |
8,497 |
$122K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,628 |
1,515 |
$45K |
| V2020 |
Frames, purchases |
1,199 |
1,106 |
$20K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
313 |
292 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,124 |
1,047 |
$16K |
| V2025 |
Deluxe frame |
257 |
250 |
$13K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
186 |
170 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
59 |
57 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
46 |
44 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
32 |
32 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
75 |
72 |
$795.94 |