| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,205 |
3,201 |
$43K |
| V2020 |
Frames, purchases |
2,660 |
2,627 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,728 |
1,645 |
$10K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
191 |
190 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,677 |
961 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
108 |
108 |
$5K |
| 92250 |
|
109 |
109 |
$4K |
| 92015 |
Determination of refractive state |
1,245 |
1,244 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
176 |
176 |
$486.80 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
68 |
37 |
$208.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
388 |
203 |
$170.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
57 |
57 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
170 |
83 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
54 |
54 |
$0.00 |