| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,898 |
1,387 |
$58K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,249 |
1,243 |
$52K |
| V2020 |
Frames, purchases |
2,723 |
2,636 |
$36K |
| 99215 |
Prolong outpt/office vis |
487 |
468 |
$35K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
339 |
339 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,085 |
2,612 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
328 |
164 |
$7K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
12 |
12 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
28 |
14 |
$800.24 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
16 |
16 |
$640.00 |
| 92015 |
Determination of refractive state |
29 |
29 |
$0.00 |