| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
81 |
81 |
$2K |
| V2020 |
Frames, purchases |
87 |
87 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
28 |
28 |
$1K |
| 92015 |
Determination of refractive state |
82 |
82 |
$934.38 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
19 |
19 |
$843.46 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
53 |
53 |
$663.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
13 |
$595.27 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$558.48 |
| 92250 |
|
29 |
29 |
$204.70 |