| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
951 |
951 |
$38K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
714 |
713 |
$29K |
| V2020 |
Frames, purchases |
2,333 |
2,325 |
$26K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
906 |
450 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
641 |
353 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
37 |
37 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
54 |
51 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
47 |
47 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
40 |
40 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,199 |
2,605 |
$0.00 |