| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,954 |
2,900 |
$137K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
1,411 |
1,359 |
$103K |
| V2020 |
Frames, purchases |
2,326 |
2,286 |
$96K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,458 |
1,412 |
$45K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
571 |
571 |
$37K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
645 |
577 |
$35K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
706 |
695 |
$31K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
319 |
299 |
$23K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
139 |
130 |
$13K |
| V2025 |
Deluxe frame |
333 |
329 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,388 |
1,346 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
68 |
68 |
$6K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
71 |
70 |
$4K |
| 92015 |
Determination of refractive state |
889 |
884 |
$0.00 |