| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
120 |
108 |
$8K |
| V2020 |
Frames, purchases |
146 |
130 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
28 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
105 |
64 |
$923.90 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
53 |
49 |
$602.88 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
27 |
27 |
$116.19 |
| 92015 |
Determination of refractive state |
171 |
150 |
$20.22 |