| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
16 |
15 |
$640.00 |
| V2020 |
Frames, purchases |
51 |
51 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
27 |
27 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
21 |
21 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
58 |
29 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
40 |
20 |
$0.00 |