| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,271 |
2,224 |
$215K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,958 |
2,866 |
$201K |
| V2020 |
Frames, purchases |
4,175 |
3,995 |
$98K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,188 |
2,109 |
$53K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
504 |
490 |
$14K |
| 92015 |
Determination of refractive state |
876 |
856 |
$13K |
| 92250 |
|
254 |
215 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
467 |
438 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
103 |
96 |
$5K |
| V2756 |
Eye glass case |
3,935 |
3,758 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
102 |
92 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
12 |
$331.76 |