| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
339 |
332 |
$36K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
488 |
466 |
$28K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
339 |
335 |
$22K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
244 |
233 |
$20K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
371 |
361 |
$15K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
83 |
81 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
78 |
69 |
$2K |
| V2020 |
Frames, purchases |
76 |
67 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
80 |
71 |
$1K |
| 92015 |
Determination of refractive state |
2,152 |
2,110 |
$73.62 |
| V2756 |
Eye glass case |
46 |
38 |
$45.36 |