| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,953 |
3,655 |
$316K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,346 |
3,075 |
$215K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
2,782 |
2,705 |
$36K |
| 92015 |
Determination of refractive state |
6,267 |
5,756 |
$34K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
357 |
290 |
$13K |
| V2020 |
Frames, purchases |
58 |
57 |
$923.62 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
32 |
31 |
$626.00 |
| 92133 |
|
34 |
28 |
$499.22 |
| 92134 |
|
15 |
13 |
$271.80 |
| 3072F |
|
239 |
180 |
$10.00 |