| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
91 |
91 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
147 |
135 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
76 |
76 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
428 |
211 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,510 |
779 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
991 |
535 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,377 |
1,377 |
$0.00 |
| V2020 |
Frames, purchases |
1,259 |
1,249 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
130 |
65 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
944 |
511 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
73 |
73 |
$0.00 |