| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,136 |
904 |
$76K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
952 |
761 |
$48K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,239 |
952 |
$28K |
| V2020 |
Frames, purchases |
1,500 |
1,121 |
$21K |
| 92015 |
Determination of refractive state |
2,206 |
1,758 |
$11K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
283 |
206 |
$8K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
599 |
508 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
742 |
513 |
$5K |
| 92250 |
|
46 |
37 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
12 |
$690.66 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
241 |
160 |
$568.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
39 |
13 |
$183.35 |