| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
334 |
333 |
$15K |
| 87811 |
Infectious agent antigen detection by immunoassay; SARS-CoV-2 (COVID-19) |
360 |
193 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
192 |
186 |
$8K |
| 92250 |
|
108 |
108 |
$3K |
| V2020 |
Frames, purchases |
215 |
215 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
20 |
16 |
$1K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
72 |
20 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
12 |
12 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
204 |
204 |
$754.00 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
54 |
35 |
$337.50 |
| V2102 |
Sphere, single vision, plus or minus 7.12 to plus or minus 20.00d, per lens |
41 |
32 |
$262.50 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
207 |
207 |
$106.06 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
21 |
13 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
25 |
16 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
81 |
81 |
$0.00 |
| 92015 |
Determination of refractive state |
17 |
17 |
$0.00 |