| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
506 |
403 |
$12K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
101 |
65 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
35 |
26 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
66 |
54 |
$2K |
| 92015 |
Determination of refractive state |
132 |
110 |
$942.35 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
13 |
$483.08 |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
20 |
15 |
$109.74 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
26 |
26 |
$0.00 |