| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$117.50 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,252 |
1,252 |
$52.00 |
| V2020 |
Frames, purchases |
3,530 |
3,520 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
539 |
278 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,804 |
2,804 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
77 |
77 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
3,681 |
1,861 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
3,661 |
1,853 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,360 |
2,235 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,396 |
1,249 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
62 |
31 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
1,085 |
551 |
$0.00 |
| V2781 |
Progressive lens, per lens |
286 |
143 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,523 |
1,280 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
82 |
41 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
218 |
109 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
71 |
71 |
$0.00 |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
66 |
33 |
$0.00 |