| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
80 |
79 |
$4K |
| V2020 |
Frames, purchases |
61 |
57 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
57 |
57 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
54 |
54 |
$2K |
| 92015 |
Determination of refractive state |
273 |
268 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
61 |
30 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
15 |
15 |
$619.05 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
12 |
$0.00 |