| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
264 |
264 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
71 |
60 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
392 |
392 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
22 |
13 |
$1K |
| V2025 |
Deluxe frame |
21 |
12 |
$226.80 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
18 |
18 |
$135.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
14 |
$0.00 |