| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92133 |
|
228 |
227 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
80 |
78 |
$2K |
| 76514 |
|
12 |
12 |
$132.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,264 |
631 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,362 |
678 |
$0.00 |
| V2599 |
Contact lens, other type |
128 |
128 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
54 |
27 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
960 |
490 |
$0.00 |
| 92250 |
|
19 |
19 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
48 |
24 |
$0.00 |
| V2781 |
Progressive lens, per lens |
56 |
28 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,766 |
1,766 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
448 |
224 |
$0.00 |
| V2020 |
Frames, purchases |
1,834 |
1,829 |
$0.00 |
| V2500 |
Contact lens, pmma, spherical, per lens |
15 |
15 |
$0.00 |
| 92015 |
Determination of refractive state |
20 |
20 |
$0.00 |