| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
398 |
392 |
$12K |
| V2020 |
Frames, purchases |
280 |
278 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
68 |
68 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
40 |
40 |
$1K |
| 92133 |
|
54 |
53 |
$500.37 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$351.15 |
| 92275 |
|
14 |
14 |
$211.77 |
| 92015 |
Determination of refractive state |
164 |
164 |
$142.45 |
| 92100 |
|
16 |
16 |
$59.30 |
| 92083 |
|
15 |
15 |
$23.15 |
| 76514 |
|
15 |
15 |
$20.92 |