| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
225 |
210 |
$24K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
221 |
219 |
$19K |
| 92015 |
Determination of refractive state |
1,130 |
1,098 |
$13K |
| V2020 |
Frames, purchases |
378 |
369 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
168 |
167 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
71 |
71 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$462.70 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
12 |
12 |
$449.96 |