| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
670 |
669 |
$8K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
14 |
14 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
55 |
55 |
$541.00 |
| 92015 |
Determination of refractive state |
293 |
292 |
$417.20 |
| V2020 |
Frames, purchases |
549 |
547 |
$40.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
95 |
50 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
135 |
79 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
30 |
15 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
34 |
34 |
$0.00 |