| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
88 |
76 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
638 |
356 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
642 |
358 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
252 |
250 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
58 |
33 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
56 |
28 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
629 |
629 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
468 |
255 |
$0.00 |
| V2020 |
Frames, purchases |
827 |
824 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
141 |
85 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
178 |
178 |
$0.00 |