| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
137 |
100 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
18 |
18 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
14 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
12 |
$711.36 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
13 |
13 |
$445.50 |
| V2020 |
Frames, purchases |
15 |
15 |
$408.75 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
22 |
12 |
$319.30 |
| 92015 |
Determination of refractive state |
82 |
81 |
$283.08 |