| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
759 |
722 |
$43K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
382 |
371 |
$29K |
| V2020 |
Frames, purchases |
697 |
686 |
$21K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
748 |
739 |
$15K |
| 92015 |
Determination of refractive state |
1,316 |
1,272 |
$14K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
276 |
270 |
$13K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
102 |
101 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
239 |
234 |
$3K |
| 92341 |
|
129 |
129 |
$3K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
33 |
33 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
14 |
14 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
14 |
13 |
$687.82 |
| 92250 |
|
13 |
13 |
$288.81 |
| V2755 |
U-v lens, per lens |
203 |
202 |
$79.67 |
| V2760 |
Scratch resistant coating, per lens |
44 |
44 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
92 |
91 |
$0.00 |