| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
191 |
150 |
$7K |
| V2020 |
Frames, purchases |
204 |
164 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
53 |
50 |
$3K |
| 92083 |
|
29 |
29 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
91 |
70 |
$2K |
| 92250 |
|
12 |
12 |
$404.11 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$360.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
19 |
12 |
$144.00 |
| 92015 |
Determination of refractive state |
229 |
181 |
$0.00 |