| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
203 |
194 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
42 |
42 |
$2K |
| 92015 |
Determination of refractive state |
165 |
152 |
$963.36 |
| V2020 |
Frames, purchases |
72 |
70 |
$782.01 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
27 |
27 |
$422.00 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
36 |
26 |
$0.00 |