| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,331 |
1,313 |
$83K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
794 |
790 |
$71K |
| V2020 |
Frames, purchases |
857 |
822 |
$22K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
46 |
40 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
12 |
12 |
$452.08 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15 |
12 |
$427.60 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$344.96 |
| 92015 |
Determination of refractive state |
75 |
65 |
$60.20 |