| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
419 |
391 |
$23K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
166 |
166 |
$14K |
| V2020 |
Frames, purchases |
528 |
507 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
117 |
111 |
$5K |
| 92250 |
|
107 |
106 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
91 |
50 |
$2K |
| 92083 |
|
25 |
25 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
77 |
39 |
$12.00 |
| 92015 |
Determination of refractive state |
35 |
35 |
$0.00 |