| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
534 |
528 |
$19K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,437 |
2,420 |
$8K |
| 92226 |
|
188 |
188 |
$4K |
| 92134 |
|
64 |
64 |
$1K |
| 92250 |
|
29 |
29 |
$796.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
152 |
152 |
$86.00 |
| 92015 |
Determination of refractive state |
387 |
386 |
$0.00 |
| V2020 |
Frames, purchases |
2,507 |
2,491 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
212 |
115 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
107 |
107 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
812 |
436 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,697 |
1,380 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,391 |
1,237 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
25 |
13 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
34 |
34 |
$0.00 |