| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
403 |
395 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
229 |
227 |
$11K |
| V2020 |
Frames, purchases |
321 |
302 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
323 |
255 |
$5K |
| 92015 |
Determination of refractive state |
776 |
753 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
151 |
76 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
47 |
24 |
$883.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
20 |
12 |
$204.12 |
| 1036F |
|
68 |
58 |
$0.00 |
| 4004F |
|
17 |
14 |
$0.00 |