| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
563 |
513 |
$38K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
260 |
230 |
$12K |
| V2020 |
Frames, purchases |
493 |
458 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
70 |
54 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
101 |
90 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
198 |
188 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
31 |
30 |
$3K |
| 92002 |
|
12 |
12 |
$351.24 |
| 92250 |
|
13 |
12 |
$306.06 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$144.75 |
| 92015 |
Determination of refractive state |
393 |
352 |
$0.00 |