| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
15 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
35 |
34 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$519.13 |
| 92015 |
Determination of refractive state |
96 |
96 |
$443.52 |
| V2020 |
Frames, purchases |
12 |
12 |
$416.57 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
22 |
12 |
$121.00 |