| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
1,041 |
1,000 |
$134K |
| 92015 |
Determination of refractive state |
3,436 |
3,268 |
$55K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
655 |
643 |
$50K |
| 68761 |
|
995 |
282 |
$49K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
785 |
766 |
$41K |
| V2020 |
Frames, purchases |
938 |
928 |
$26K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
285 |
277 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
204 |
196 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
284 |
283 |
$10K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
456 |
449 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
266 |
264 |
$5K |
| 92250 |
|
83 |
74 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
347 |
339 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
17 |
17 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$693.00 |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$0.00 |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
26 |
26 |
$0.00 |