| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
760 |
734 |
$68K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
817 |
788 |
$52K |
| V2020 |
Frames, purchases |
1,179 |
1,127 |
$29K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
343 |
316 |
$8K |
| V2756 |
Eye glass case |
1,194 |
1,141 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
19 |
19 |
$484.88 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14 |
12 |
$475.53 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
28 |
27 |
$411.74 |
| 92015 |
Determination of refractive state |
32 |
28 |
$0.00 |