| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,090 |
1,165 |
$110K |
| 92250 |
|
1,378 |
1,372 |
$72K |
| V2020 |
Frames, purchases |
2,391 |
1,416 |
$71K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,297 |
1,282 |
$59K |
| 92083 |
|
637 |
635 |
$42K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
587 |
586 |
$39K |
| V2750 |
Anti-reflective coating, per lens |
1,125 |
415 |
$21K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,300 |
1,245 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
239 |
221 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
192 |
188 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
68 |
18 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28 |
27 |
$1K |
| 76514 |
|
27 |
27 |
$265.42 |