| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
664 |
657 |
$59K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
834 |
821 |
$59K |
| V2020 |
Frames, purchases |
1,186 |
1,027 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
637 |
529 |
$10K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
162 |
162 |
$8K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
427 |
426 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
247 |
247 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
20 |
13 |
$599.45 |
| 92015 |
Determination of refractive state |
1,771 |
1,621 |
$0.00 |