| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,254 |
1,253 |
$91K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
955 |
947 |
$54K |
| 92250 |
|
978 |
976 |
$46K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,707 |
965 |
$27K |
| V2020 |
Frames, purchases |
1,556 |
1,535 |
$27K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
94 |
94 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
87 |
83 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
147 |
84 |
$3K |
| 92083 |
|
38 |
38 |
$2K |
| 92133 |
|
26 |
26 |
$726.40 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
13 |
$488.12 |
| 92015 |
Determination of refractive state |
12 |
12 |
$296.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
487 |
250 |
$102.00 |
| V2755 |
U-v lens, per lens |
114 |
57 |
$0.00 |