| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
737 |
737 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
370 |
370 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
405 |
299 |
$4K |
| V2020 |
Frames, purchases |
494 |
493 |
$4K |
| 92015 |
Determination of refractive state |
931 |
925 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
94 |
94 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
147 |
111 |
$934.80 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
380 |
368 |
$357.62 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
17 |
17 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
82 |
63 |
$0.00 |