| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
222 |
220 |
$10K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
139 |
139 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
164 |
77 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
32 |
32 |
$2K |
| 92015 |
Determination of refractive state |
73 |
73 |
$2K |
| V2020 |
Frames, purchases |
142 |
138 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
13 |
13 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
64 |
64 |
$949.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
94 |
46 |
$0.00 |