| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
13 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$817.30 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16 |
12 |
$250.35 |
| V2020 |
Frames, purchases |
15 |
12 |
$166.32 |