| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
603 |
591 |
$38K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
407 |
401 |
$37K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
642 |
606 |
$34K |
| 92015 |
Determination of refractive state |
912 |
884 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
84 |
76 |
$3K |
| V2020 |
Frames, purchases |
104 |
87 |
$1K |
| 92341 |
|
14 |
14 |
$884.00 |
| 92250 |
|
14 |
14 |
$506.07 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
50 |
37 |
$259.00 |
| S9999 |
Sales tax |
12 |
12 |
$22.68 |