| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,186 |
1,156 |
$64K |
| 92250 |
|
1,322 |
1,260 |
$59K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
859 |
797 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
689 |
670 |
$28K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
138 |
138 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
55 |
53 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
50 |
39 |
$1K |
| 92015 |
Determination of refractive state |
49 |
49 |
$220.50 |