| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
335 |
330 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
541 |
541 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
835 |
832 |
$3K |
| 92250 |
|
109 |
109 |
$2K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
25 |
25 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
12 |
$461.46 |
| V2020 |
Frames, purchases |
1,602 |
1,585 |
$440.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
771 |
430 |
$294.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
41 |
24 |
$130.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
121 |
67 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
78 |
78 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
48 |
24 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
903 |
492 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
31 |
31 |
$0.00 |