| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
669 |
591 |
$32K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
409 |
385 |
$32K |
| V2020 |
Frames, purchases |
983 |
944 |
$25K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
317 |
307 |
$8K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
51 |
50 |
$6K |
| 92250 |
|
152 |
121 |
$4K |
| 92083 |
|
38 |
28 |
$865.34 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13 |
12 |
$727.53 |
| V2756 |
Eye glass case |
642 |
626 |
$664.04 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
13 |
$480.22 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$318.96 |
| 92015 |
Determination of refractive state |
929 |
862 |
$207.69 |