| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,418 |
1,318 |
$84K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
858 |
820 |
$40K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
671 |
636 |
$33K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
888 |
799 |
$29K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
340 |
329 |
$17K |
| 92015 |
Determination of refractive state |
1,454 |
1,380 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
200 |
193 |
$12K |
| 92250 |
|
162 |
154 |
$4K |
| 92083 |
|
35 |
30 |
$853.32 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$797.78 |
| 92133 |
|
40 |
36 |
$751.75 |
| S9999 |
Sales tax |
29 |
25 |
$0.00 |