| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,032 |
1,018 |
$45K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,329 |
1,307 |
$25K |
| 92015 |
Determination of refractive state |
691 |
613 |
$11K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
162 |
140 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
131 |
129 |
$6K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
45 |
43 |
$3K |
| V2020 |
Frames, purchases |
73 |
73 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
15 |
$383.20 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
30 |
30 |
$357.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$302.80 |
| 92133 |
|
13 |
12 |
$201.85 |