| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,241 |
1,196 |
$74K |
| V2020 |
Frames, purchases |
1,610 |
1,525 |
$38K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
168 |
166 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
356 |
316 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
206 |
181 |
$4K |
| 92370 |
|
263 |
247 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
113 |
105 |
$3K |
| 92250 |
|
74 |
68 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
36 |
35 |
$827.96 |
| V2756 |
Eye glass case |
771 |
744 |
$780.84 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
19 |
16 |
$734.91 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
20 |
20 |
$535.63 |
| 92083 |
|
15 |
14 |
$526.60 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
21 |
21 |
$382.80 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
31 |
29 |
$201.00 |
| 92015 |
Determination of refractive state |
225 |
217 |
$0.00 |