| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| H1000 |
Prenatal care, at-risk assessment |
53 |
38 |
$0.00 |
| V2025 |
Deluxe frame |
14 |
14 |
$0.00 |
| S9083 |
Global fee urgent care centers |
134 |
131 |
$0.00 |
| V2020 |
Frames, purchases |
31 |
31 |
$0.00 |
| 92015 |
Determination of refractive state |
57 |
57 |
$0.00 |
| 99284 |
Emergency department visit for the evaluation and management, high severity |
76 |
74 |
$0.00 |
| 90460 |
Immunization administration through 18 years of age via any route, first or only component |
12 |
12 |
$0.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
111 |
101 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
30 |
30 |
$0.00 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
30 |
29 |
$0.00 |
| H2019 |
Therapeutic behavioral services, per 15 minutes |
48 |
42 |
$0.00 |
| 99283 |
Emergency department visit for the evaluation and management, moderate severity |
62 |
60 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
29 |
26 |
$0.00 |
| 99285 |
Emergency department visit for the evaluation and management, high severity with immediate threat to life |
105 |
103 |
$0.00 |