| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
315 |
315 |
$16K |
| V2020 |
Frames, purchases |
432 |
432 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
150 |
150 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
319 |
319 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
157 |
157 |
$3K |
| 92015 |
Determination of refractive state |
510 |
510 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
50 |
45 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
73 |
73 |
$2K |