| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
85 |
85 |
$6K |
| 92250 |
|
89 |
89 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
16 |
16 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
24 |
24 |
$981.76 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
17 |
13 |
$386.08 |
| V2020 |
Frames, purchases |
13 |
13 |
$227.60 |