| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
338 |
334 |
$26K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
106 |
103 |
$13K |
| V2020 |
Frames, purchases |
138 |
123 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
132 |
119 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
91 |
91 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
18 |
18 |
$829.44 |