| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,322 |
2,293 |
$109K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,989 |
1,947 |
$86K |
| V2025 |
Deluxe frame |
508 |
508 |
$28K |
| V2020 |
Frames, purchases |
657 |
654 |
$27K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
376 |
365 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
706 |
706 |
$20K |
| 92015 |
Determination of refractive state |
3,257 |
3,120 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
116 |
103 |
$7K |
| 92250 |
|
14 |
13 |
$431.03 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
359 |
359 |
$205.05 |
| V2750 |
Anti-reflective coating, per lens |
60 |
60 |
$14.88 |
| G8428 |
Current list of medications not documented as obtained, updated, or reviewed by the eligible clinician, reason not given |
19 |
15 |
$0.00 |
| G8732 |
No documentation of pain assessment, reason not given |
19 |
15 |
$0.00 |