| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
132 |
125 |
$25K |
| V2020 |
Frames, purchases |
1,375 |
1,372 |
$24K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,003 |
1,003 |
$12K |
| V2750 |
Anti-reflective coating, per lens |
123 |
122 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
931 |
929 |
$7K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
46 |
46 |
$6K |
| 92015 |
Determination of refractive state |
1,564 |
1,563 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
116 |
116 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
12 |
12 |
$1K |
| V2756 |
Eye glass case |
67 |
67 |
$330.00 |
| V2755 |
U-v lens, per lens |
15 |
15 |
$300.00 |
| 92341 |
|
12 |
12 |
$0.00 |