| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,534 |
2,427 |
$157K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,597 |
1,554 |
$143K |
| V2020 |
Frames, purchases |
2,453 |
2,298 |
$62K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,428 |
832 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
853 |
531 |
$12K |
| 92015 |
Determination of refractive state |
744 |
705 |
$9K |
| 92250 |
|
168 |
151 |
$7K |
| V2756 |
Eye glass case |
2,134 |
2,031 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
31 |
26 |
$816.67 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
17 |
13 |
$517.16 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
23 |
12 |
$369.40 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
20 |
12 |
$255.20 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
16 |
14 |
$17.44 |