| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,378 |
1,377 |
$37K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,040 |
1,038 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
601 |
601 |
$13K |
| 92015 |
Determination of refractive state |
1,460 |
1,460 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
30 |
27 |
$946.96 |
| V2020 |
Frames, purchases |
778 |
777 |
$240.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
450 |
229 |
$84.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,197 |
602 |
$79.04 |
| 3072F |
|
198 |
198 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
356 |
178 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
542 |
273 |
$0.00 |