| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
167 |
165 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
53 |
40 |
$817.26 |
| 92015 |
Determination of refractive state |
468 |
467 |
$588.38 |
| 92082 |
|
70 |
53 |
$455.97 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
26 |
26 |
$200.64 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
50 |
50 |
$116.84 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
175 |
175 |
$0.00 |
| V2025 |
Deluxe frame |
158 |
158 |
$0.00 |
| S9999 |
Sales tax |
81 |
47 |
$0.00 |