| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,419 |
711 |
$29K |
| V2020 |
Frames, purchases |
1,170 |
1,162 |
$20K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
268 |
265 |
$18K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
305 |
305 |
$16K |
| 92250 |
|
286 |
285 |
$13K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
73 |
73 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,016 |
1,012 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
42 |
40 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$674.16 |
| 92015 |
Determination of refractive state |
174 |
174 |
$642.05 |