| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,448 |
5,318 |
$76K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
344 |
342 |
$42K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,355 |
2,292 |
$37K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,775 |
5,618 |
$35K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,845 |
1,807 |
$31K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
149 |
149 |
$27K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
198 |
196 |
$17K |
| 92015 |
Determination of refractive state |
729 |
728 |
$16K |
| 92060 |
|
221 |
220 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
651 |
622 |
$10K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
42 |
42 |
$5K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
80 |
74 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$398.08 |
| V2750 |
Anti-reflective coating, per lens |
17 |
17 |
$0.00 |