| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
528 |
527 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
353 |
349 |
$9K |
| V2020 |
Frames, purchases |
324 |
320 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
344 |
340 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16 |
13 |
$947.30 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
14 |
14 |
$635.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
14 |
14 |
$635.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$480.00 |
| 92015 |
Determination of refractive state |
659 |
658 |
$0.00 |