| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
140 |
133 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
43 |
43 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
37 |
37 |
$2K |
| V2020 |
Frames, purchases |
77 |
76 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
60 |
59 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
39 |
38 |
$507.00 |
| 92250 |
|
14 |
12 |
$274.39 |
| 92083 |
|
13 |
12 |
$242.55 |
| 92015 |
Determination of refractive state |
77 |
77 |
$0.00 |