| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92225 |
|
33 |
17 |
$891.68 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$570.00 |
| 92250 |
|
17 |
17 |
$235.06 |
| V2020 |
Frames, purchases |
326 |
316 |
$0.00 |
| 92015 |
Determination of refractive state |
14 |
14 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
101 |
101 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
67 |
54 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
45 |
24 |
$0.00 |