| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
425 |
419 |
$20K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
618 |
602 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
241 |
235 |
$10K |
| V2020 |
Frames, purchases |
619 |
606 |
$10K |
| 92015 |
Determination of refractive state |
310 |
293 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
25 |
25 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
24 |
24 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$516.06 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
26 |
26 |
$464.00 |