| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
76 |
75 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
38 |
38 |
$5K |
| 92015 |
Determination of refractive state |
297 |
291 |
$4K |
| V2020 |
Frames, purchases |
134 |
130 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
19 |
17 |
$738.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$646.88 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
14 |
13 |
$569.80 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
14 |
14 |
$525.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
14 |
$298.56 |