| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
916 |
513 |
$35K |
| V2020 |
Frames, purchases |
533 |
514 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
139 |
73 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
63 |
52 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
200 |
159 |
$3K |
| 92285 |
|
72 |
52 |
$2K |
| 92250 |
|
28 |
26 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
163 |
160 |
$282.16 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$267.96 |
| 92015 |
Determination of refractive state |
1,254 |
728 |
$0.00 |