| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
166 |
153 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
97 |
84 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
16 |
15 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
138 |
137 |
$187.80 |
| V2020 |
Frames, purchases |
116 |
115 |
$59.84 |
| 92015 |
Determination of refractive state |
119 |
102 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
62 |
62 |
$0.00 |