| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
87 |
84 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$2K |
| 92015 |
Determination of refractive state |
88 |
88 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
26 |
26 |
$779.48 |
| V2020 |
Frames, purchases |
28 |
28 |
$280.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
25 |
25 |
$0.00 |