| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,276 |
3,124 |
$144K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,556 |
3,402 |
$139K |
| V2020 |
Frames, purchases |
5,502 |
5,196 |
$62K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,783 |
3,621 |
$61K |
| 92015 |
Determination of refractive state |
7,081 |
6,742 |
$18K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,911 |
2,709 |
$9K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
426 |
369 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
337 |
312 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
114 |
112 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
136 |
118 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
14 |
12 |
$2K |
| 92250 |
|
63 |
33 |
$919.49 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
26 |
25 |
$362.44 |
| 92134 |
|
21 |
12 |
$54.35 |
| V2744 |
Tint, photochromatic, per lens |
37 |
29 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
417 |
376 |
$0.00 |