| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
165 |
163 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
113 |
108 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,446 |
1,445 |
$566.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,261 |
1,260 |
$156.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,910 |
2,548 |
$80.00 |
| V2020 |
Frames, purchases |
2,904 |
2,886 |
$64.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
236 |
123 |
$19.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
878 |
466 |
$17.00 |
| 92015 |
Determination of refractive state |
1,130 |
1,128 |
$4.40 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,166 |
1,650 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
61 |
61 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
84 |
84 |
$0.00 |