| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,849 |
1,812 |
$120K |
| V2020 |
Frames, purchases |
2,378 |
2,268 |
$59K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,007 |
977 |
$46K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,600 |
1,416 |
$33K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
328 |
324 |
$28K |
| 92002 |
|
309 |
305 |
$17K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
604 |
362 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
571 |
343 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,317 |
2,214 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
53 |
48 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
14 |
$861.13 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
25 |
25 |
$476.00 |
| V2756 |
Eye glass case |
294 |
286 |
$305.64 |
| 92015 |
Determination of refractive state |
3,945 |
3,861 |
$210.70 |