| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,281 |
1,278 |
$15K |
| 92225 |
|
274 |
250 |
$12K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
42 |
42 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
693 |
371 |
$2K |
| 92015 |
Determination of refractive state |
430 |
428 |
$2K |
| V2020 |
Frames, purchases |
871 |
866 |
$880.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
17 |
16 |
$850.00 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
37 |
35 |
$693.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
785 |
402 |
$84.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
188 |
188 |
$26.00 |
| V2599 |
Contact lens, other type |
220 |
220 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
35 |
35 |
$0.00 |
| 2023F |
|
24 |
24 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
12 |
$0.00 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
288 |
288 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
81 |
81 |
$0.00 |
| V2500 |
Contact lens, pmma, spherical, per lens |
22 |
22 |
$0.00 |