| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
51 |
51 |
$4K |
| V2020 |
Frames, purchases |
58 |
56 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
34 |
34 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13 |
12 |
$671.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
19 |
18 |
$359.30 |
| 92015 |
Determination of refractive state |
30 |
26 |
$60.66 |