| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$480.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
369 |
368 |
$129.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
236 |
236 |
$43.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
471 |
256 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
97 |
49 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
91 |
91 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
910 |
486 |
$0.00 |
| V2020 |
Frames, purchases |
611 |
609 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
376 |
188 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
70 |
70 |
$0.00 |