| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
2,402 |
2,388 |
$137K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,404 |
1,390 |
$112K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,169 |
2,138 |
$92K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,638 |
2,594 |
$53K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
487 |
479 |
$46K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
941 |
932 |
$40K |
| 92015 |
Determination of refractive state |
2,564 |
2,534 |
$37K |
| V2020 |
Frames, purchases |
1,738 |
1,705 |
$27K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
259 |
259 |
$8K |
| 92250 |
|
43 |
42 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
32 |
27 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
39 |
39 |
$689.08 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$674.88 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
30 |
30 |
$618.17 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$614.16 |