| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
161 |
95 |
$10K |
| V2020 |
Frames, purchases |
238 |
159 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
32 |
16 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
36 |
18 |
$582.15 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
40 |
20 |
$207.48 |