| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
30 |
30 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
40 |
40 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
39 |
39 |
$1K |
| 92002 |
|
12 |
12 |
$666.43 |
| V2020 |
Frames, purchases |
42 |
42 |
$405.03 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14 |
13 |
$385.43 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
15 |
14 |
$180.42 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
28 |
$0.00 |