| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
391 |
363 |
$28K |
| 92015 |
Determination of refractive state |
644 |
602 |
$7K |
| V2020 |
Frames, purchases |
319 |
309 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
90 |
90 |
$2K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13 |
12 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
12 |
$1K |
| V2755 |
U-v lens, per lens |
18 |
17 |
$287.81 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
57 |
57 |
$88.00 |