| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
254 |
200 |
$12K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
266 |
238 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
160 |
119 |
$7K |
| 92015 |
Determination of refractive state |
991 |
857 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
144 |
37 |
$1K |
| V2020 |
Frames, purchases |
72 |
38 |
$989.07 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
51 |
16 |
$418.25 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
15 |
15 |
$339.90 |