| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
876 |
876 |
$51K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
402 |
400 |
$24K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
441 |
441 |
$23K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
197 |
190 |
$19K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
156 |
148 |
$11K |
| 92015 |
Determination of refractive state |
402 |
391 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
80 |
80 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
309 |
309 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
19 |
19 |
$2K |
| 92250 |
|
28 |
27 |
$2K |
| 83861 |
|
30 |
14 |
$357.86 |