| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
189 |
185 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
167 |
167 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
71 |
67 |
$5K |
| 92015 |
Determination of refractive state |
353 |
352 |
$5K |
| 92285 |
|
113 |
91 |
$3K |
| V2020 |
Frames, purchases |
79 |
79 |
$3K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
36 |
36 |
$2K |
| 92250 |
|
42 |
42 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
38 |
35 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
82 |
81 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
61 |
60 |
$689.04 |