| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
67 |
65 |
$4K |
| V2020 |
Frames, purchases |
153 |
148 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
31 |
29 |
$1K |
| 92002 |
|
17 |
15 |
$770.96 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
18 |
16 |
$650.72 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
12 |
$350.72 |
| V2756 |
Eye glass case |
92 |
91 |
$98.28 |
| 92015 |
Determination of refractive state |
76 |
73 |
$0.00 |