| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
277 |
270 |
$25K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
290 |
289 |
$20K |
| V2020 |
Frames, purchases |
667 |
629 |
$18K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
507 |
485 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
305 |
292 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
467 |
447 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
93 |
88 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
32 |
26 |
$1K |
| 92015 |
Determination of refractive state |
848 |
813 |
$869.46 |
| 92250 |
|
12 |
12 |
$539.11 |