| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,045 |
1,010 |
$94K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,172 |
1,140 |
$79K |
| V2020 |
Frames, purchases |
2,290 |
2,147 |
$64K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,035 |
1,955 |
$61K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,215 |
1,144 |
$21K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
314 |
272 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,193 |
1,128 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
375 |
352 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
173 |
151 |
$5K |
| V2781 |
Progressive lens, per lens |
122 |
122 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
28 |
28 |
$2K |
| 92015 |
Determination of refractive state |
2,458 |
2,386 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
27 |
27 |
$380.00 |
| 99199 |
Unlisted special service, procedure or report |
20 |
15 |
$0.00 |