| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,193 |
3,086 |
$314K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,262 |
1,216 |
$145K |
| V2020 |
Frames, purchases |
998 |
969 |
$49K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
762 |
677 |
$16K |
| 92015 |
Determination of refractive state |
5,685 |
5,464 |
$12K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
420 |
315 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15 |
12 |
$983.50 |
| 92250 |
|
14 |
13 |
$141.96 |
| V2760 |
Scratch resistant coating, per lens |
246 |
231 |
$20.90 |