| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,053 |
2,931 |
$198K |
| V2020 |
Frames, purchases |
2,162 |
2,025 |
$57K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
262 |
251 |
$23K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,002 |
567 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
195 |
135 |
$3K |
| 92250 |
|
53 |
50 |
$2K |
| V2756 |
Eye glass case |
1,811 |
1,724 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
14 |
$734.80 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
12 |
$263.07 |
| 92370 |
|
17 |
17 |
$255.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
16 |
16 |
$34.88 |
| 92015 |
Determination of refractive state |
35 |
29 |
$0.00 |