| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
305 |
275 |
$4K |
| V2020 |
Frames, purchases |
298 |
282 |
$2K |
| 92250 |
|
184 |
162 |
$1K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
101 |
75 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
21 |
17 |
$146.28 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
75 |
67 |
$123.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
31 |
27 |
$75.00 |
| 92015 |
Determination of refractive state |
218 |
186 |
$0.00 |