| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
71 |
71 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
340 |
164 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
267 |
267 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
127 |
61 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
404 |
202 |
$0.00 |
| V2020 |
Frames, purchases |
303 |
291 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
124 |
62 |
$0.00 |