| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,562 |
1,557 |
$47K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,215 |
1,213 |
$16K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
110 |
109 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
143 |
143 |
$4K |
| 92015 |
Determination of refractive state |
1,555 |
1,553 |
$4K |
| V2020 |
Frames, purchases |
698 |
696 |
$380.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
64 |
38 |
$21.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
93 |
93 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
299 |
244 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
62 |
31 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$0.00 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
125 |
125 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$0.00 |