| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,979 |
2,867 |
$260K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,496 |
3,340 |
$225K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
595 |
579 |
$25K |
| 92015 |
Determination of refractive state |
1,726 |
1,574 |
$19K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
156 |
134 |
$5K |
| V2020 |
Frames, purchases |
677 |
460 |
$5K |
| 92250 |
|
93 |
83 |
$3K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
70 |
61 |
$2K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
27 |
24 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
310 |
203 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
46 |
43 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
27 |
25 |
$912.70 |
| S0516 |
Safety eyeglass frames |
26 |
26 |
$439.96 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
26 |
26 |
$242.12 |
| V2760 |
Scratch resistant coating, per lens |
43 |
40 |
$157.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$0.00 |