| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
121 |
119 |
$11K |
| V2020 |
Frames, purchases |
259 |
251 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
94 |
93 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
89 |
88 |
$3K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
168 |
161 |
$2K |
| 92015 |
Determination of refractive state |
99 |
97 |
$469.30 |
| 2023F |
|
51 |
51 |
$0.00 |