| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
169 |
161 |
$4K |
| 92225 |
|
168 |
166 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
176 |
176 |
$472.00 |
| 92250 |
|
12 |
12 |
$362.57 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
622 |
619 |
$297.00 |
| V2020 |
Frames, purchases |
571 |
554 |
$33.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
247 |
147 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
340 |
230 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
14 |
14 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
22 |
22 |
$0.00 |