| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
495 |
392 |
$24K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
291 |
237 |
$15K |
| 92015 |
Determination of refractive state |
1,361 |
1,162 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
276 |
156 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
131 |
126 |
$4K |
| V2020 |
Frames, purchases |
216 |
160 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
38 |
38 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
24 |
24 |
$862.95 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
35 |
29 |
$742.62 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
32 |
25 |
$604.31 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
18 |
12 |
$574.12 |