| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
81 |
81 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
59 |
59 |
$3K |
| V2020 |
Frames, purchases |
60 |
60 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
65 |
65 |
$2K |
| 92015 |
Determination of refractive state |
64 |
63 |
$620.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
58 |
58 |
$206.22 |