| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92225 |
|
551 |
551 |
$28K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
291 |
291 |
$21K |
| 92250 |
|
583 |
583 |
$13K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
109 |
109 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
348 |
348 |
$86.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
328 |
164 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
65 |
65 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
160 |
80 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
30 |
15 |
$0.00 |
| V2020 |
Frames, purchases |
207 |
207 |
$0.00 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
13 |
13 |
$0.00 |
| V2500 |
Contact lens, pmma, spherical, per lens |
12 |
12 |
$0.00 |