| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
324 |
286 |
$12K |
| 92225 |
|
12 |
12 |
$632.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
557 |
294 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
225 |
225 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
31 |
31 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,019 |
539 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
91 |
52 |
$0.00 |
| V2020 |
Frames, purchases |
661 |
661 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
644 |
644 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
54 |
54 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
36 |
18 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
14 |
$0.00 |