| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,555 |
3,339 |
$298K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,660 |
1,622 |
$187K |
| V2020 |
Frames, purchases |
2,107 |
2,037 |
$61K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,876 |
1,037 |
$52K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
553 |
547 |
$47K |
| 99393 |
Periodic comprehensive preventive medicine reevaluation, established patient, late childhood (5-11 years) |
450 |
439 |
$36K |
| 99392 |
Periodic comprehensive preventive medicine reevaluation, established patient, early childhood (1-4 years) |
389 |
387 |
$29K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,423 |
1,166 |
$28K |
| 99394 |
Periodic comprehensive preventive medicine reevaluation, established patient, adolescent (12-17 years) |
347 |
338 |
$28K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
493 |
473 |
$24K |
| 92015 |
Determination of refractive state |
2,925 |
2,861 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
429 |
239 |
$15K |
| 99391 |
Periodic comprehensive preventive medicine reevaluation, established patient, infant (under 1 year) |
78 |
72 |
$7K |
| 99384 |
|
29 |
28 |
$2K |
| 99383 |
|
16 |
16 |
$1K |
| V2744 |
Tint, photochromatic, per lens |
58 |
29 |
$849.70 |
| 90832 |
Psychotherapy, 30 minutes with patient |
19 |
16 |
$596.04 |
| 99173 |
|
56 |
54 |
$284.44 |