| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
464 |
459 |
$32K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
564 |
469 |
$22K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
370 |
329 |
$20K |
| V2020 |
Frames, purchases |
906 |
884 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
330 |
309 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
355 |
329 |
$15K |
| 92015 |
Determination of refractive state |
736 |
647 |
$14K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
778 |
755 |
$13K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
522 |
421 |
$8K |
| 92370 |
|
275 |
261 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
39 |
29 |
$1K |
| 92250 |
|
15 |
15 |
$484.43 |