| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
160 |
153 |
$3K |
| V2020 |
Frames, purchases |
112 |
108 |
$2K |
| 92015 |
Determination of refractive state |
218 |
209 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
13 |
13 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15 |
14 |
$984.12 |
| 92025 |
|
28 |
27 |
$471.18 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
32 |
28 |
$235.49 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
17 |
13 |
$199.35 |