| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,230 |
1,208 |
$76K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
470 |
460 |
$41K |
| V2020 |
Frames, purchases |
1,338 |
1,275 |
$33K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
761 |
730 |
$16K |
| V2756 |
Eye glass case |
1,287 |
1,244 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
37 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
26 |
24 |
$866.25 |
| 92250 |
|
12 |
12 |
$301.15 |
| 92015 |
Determination of refractive state |
1,865 |
1,830 |
$0.00 |