| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
50 |
50 |
$8K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
44 |
44 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
172 |
172 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
103 |
103 |
$3K |
| V2020 |
Frames, purchases |
208 |
201 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
71 |
70 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
17 |
17 |
$1K |
| 92015 |
Determination of refractive state |
301 |
300 |
$166.16 |