| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
61 |
35 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
22 |
12 |
$2K |
| V2020 |
Frames, purchases |
85 |
53 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
28 |
25 |
$813.33 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
29 |
29 |
$808.52 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
50 |
37 |
$288.92 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
16 |
14 |
$260.00 |