| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
286 |
276 |
$21K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
166 |
159 |
$14K |
| V2020 |
Frames, purchases |
673 |
598 |
$10K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
540 |
487 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
301 |
273 |
$5K |
| V2799 |
Vision item or service, miscellaneous |
12 |
12 |
$177.84 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
12 |
$164.05 |
| 92015 |
Determination of refractive state |
595 |
550 |
$0.00 |