| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
161 |
159 |
$9K |
| V2020 |
Frames, purchases |
180 |
180 |
$9K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
171 |
171 |
$7K |
| 92015 |
Determination of refractive state |
136 |
136 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
79 |
79 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
41 |
41 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
13 |
$555.32 |