| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
39 |
39 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
127 |
127 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
138 |
138 |
$4K |
| 92015 |
Determination of refractive state |
157 |
157 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
15 |
15 |
$2K |
| V2020 |
Frames, purchases |
132 |
132 |
$1K |
| 92020 |
|
40 |
40 |
$927.44 |
| 92250 |
|
12 |
12 |
$361.07 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
92 |
92 |
$0.00 |