| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
529 |
529 |
$49K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
236 |
236 |
$25K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
526 |
526 |
$16K |
| 92015 |
Determination of refractive state |
634 |
634 |
$11K |
| V2020 |
Frames, purchases |
524 |
524 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
172 |
172 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
109 |
109 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14 |
12 |
$530.64 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
516 |
515 |
$0.00 |