| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
499 |
489 |
$46K |
| V2020 |
Frames, purchases |
703 |
680 |
$30K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
449 |
436 |
$26K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
202 |
200 |
$20K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
510 |
501 |
$13K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
114 |
98 |
$6K |
| 92250 |
|
132 |
127 |
$5K |
| 92015 |
Determination of refractive state |
837 |
820 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$370.10 |