| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
516 |
466 |
$36K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
262 |
247 |
$16K |
| V2020 |
Frames, purchases |
524 |
459 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
485 |
242 |
$5K |
| 92250 |
|
44 |
36 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
97 |
50 |
$638.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
20 |
12 |
$427.60 |
| V2756 |
Eye glass case |
463 |
404 |
$381.24 |