| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
354 |
332 |
$48K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
984 |
970 |
$42K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
391 |
391 |
$17K |
| 92015 |
Determination of refractive state |
757 |
738 |
$14K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
128 |
120 |
$12K |
| 92250 |
|
144 |
124 |
$8K |
| V2020 |
Frames, purchases |
222 |
220 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
147 |
147 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
158 |
156 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
74 |
72 |
$977.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
55 |
55 |
$52.50 |
| V2025 |
Deluxe frame |
14 |
13 |
$0.00 |