| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,435 |
2,860 |
$159K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,295 |
2,726 |
$147K |
| 92015 |
Determination of refractive state |
6,401 |
5,329 |
$143K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
3,202 |
2,457 |
$100K |
| 92226 |
|
515 |
515 |
$13K |
| 92225 |
|
269 |
269 |
$7K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
265 |
250 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
38 |
38 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
21 |
21 |
$1K |
| 92134 |
|
15 |
12 |
$176.19 |
| 92081 |
|
15 |
15 |
$16.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,653 |
2,303 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,354 |
2,164 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
490 |
236 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
52 |
26 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
1,006 |
499 |
$0.00 |
| V2020 |
Frames, purchases |
2,783 |
2,752 |
$0.00 |