| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
689 |
688 |
$103K |
| 92250 |
|
605 |
605 |
$25K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
176 |
176 |
$20K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
67 |
67 |
$10K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
61 |
61 |
$6K |
| 92015 |
Determination of refractive state |
916 |
915 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
41 |
41 |
$2K |
| V2020 |
Frames, purchases |
65 |
65 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
15 |
$145.92 |