| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,708 |
2,680 |
$28K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
178 |
173 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
572 |
568 |
$7K |
| 92136 |
|
52 |
52 |
$892.89 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
40 |
36 |
$580.15 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
28 |
28 |
$476.30 |
| 92015 |
Determination of refractive state |
1,085 |
1,075 |
$17.60 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
438 |
215 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
196 |
96 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
24 |
12 |
$0.00 |
| V2020 |
Frames, purchases |
785 |
776 |
$0.00 |