| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
370 |
368 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
285 |
285 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
763 |
371 |
$14K |
| 92015 |
Determination of refractive state |
1,047 |
1,047 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
477 |
457 |
$7K |
| V2020 |
Frames, purchases |
501 |
487 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$786.54 |
| 92201 |
|
25 |
25 |
$402.65 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
390 |
188 |
$0.00 |
| V2755 |
U-v lens, per lens |
218 |
108 |
$0.00 |