| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
222 |
222 |
$24K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
86 |
86 |
$7K |
| 92015 |
Determination of refractive state |
338 |
338 |
$4K |
| V2020 |
Frames, purchases |
175 |
175 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$655.65 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
194 |
194 |
$0.00 |