| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,406 |
3,282 |
$205K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,592 |
1,550 |
$136K |
| V2020 |
Frames, purchases |
2,925 |
2,743 |
$71K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,003 |
921 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
717 |
694 |
$15K |
| 92370 |
|
484 |
455 |
$7K |
| 92250 |
|
110 |
97 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
99 |
85 |
$2K |
| V2756 |
Eye glass case |
2,019 |
1,883 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
15 |
15 |
$544.75 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15 |
14 |
$432.30 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$204.16 |
| 92015 |
Determination of refractive state |
13 |
13 |
$30.10 |