| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,572 |
2,568 |
$360K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
762 |
762 |
$88K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,485 |
1,481 |
$72K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,288 |
1,286 |
$64K |
| 92015 |
Determination of refractive state |
3,041 |
3,036 |
$45K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,331 |
1,326 |
$43K |
| 92250 |
|
1,698 |
1,694 |
$32K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
254 |
254 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
391 |
391 |
$17K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
24 |
$908.53 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$467.65 |
| S0590 |
Integral lens service, miscellaneous services reported separately |
369 |
369 |
$0.00 |