| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
514 |
406 |
$38K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
452 |
399 |
$30K |
| V2020 |
Frames, purchases |
579 |
521 |
$8K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
586 |
533 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
573 |
327 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
76 |
61 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
235 |
141 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
17 |
12 |
$164.05 |
| 92015 |
Determination of refractive state |
66 |
59 |
$0.00 |