| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
284 |
283 |
$20K |
| V2025 |
Deluxe frame |
222 |
215 |
$13K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
82 |
82 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
332 |
321 |
$6K |
| 92015 |
Determination of refractive state |
378 |
369 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
75 |
68 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
67 |
63 |
$2K |
| V2020 |
Frames, purchases |
34 |
34 |
$821.39 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
40 |
40 |
$621.53 |