| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
434 |
433 |
$58K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
203 |
203 |
$26K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
639 |
637 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
568 |
563 |
$16K |
| 92015 |
Determination of refractive state |
659 |
656 |
$12K |
| V2020 |
Frames, purchases |
677 |
675 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
56 |
55 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
38 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
103 |
103 |
$0.00 |