| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,100 |
1,084 |
$34K |
| V2020 |
Frames, purchases |
1,714 |
1,701 |
$31K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
626 |
624 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
908 |
894 |
$18K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
582 |
573 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
50 |
50 |
$805.20 |
| 92015 |
Determination of refractive state |
219 |
218 |
$614.74 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
15 |
15 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
28 |
28 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
29 |
29 |
$0.00 |
| V2756 |
Eye glass case |
17 |
17 |
$0.00 |