| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,212 |
1,917 |
$66K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,479 |
1,259 |
$63K |
| 92015 |
Determination of refractive state |
2,998 |
2,655 |
$54K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
399 |
317 |
$18K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
109 |
109 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
187 |
183 |
$7K |
| V2025 |
Deluxe frame |
50 |
39 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
21 |
14 |
$452.06 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
44 |
13 |
$308.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
66 |
24 |
$160.02 |