| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
204 |
199 |
$6K |
| V2020 |
Frames, purchases |
429 |
424 |
$5K |
| 92250 |
|
84 |
83 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
164 |
158 |
$968.08 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
69 |
67 |
$713.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
81 |
81 |
$519.62 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
28 |
28 |
$72.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
21 |
20 |
$42.00 |
| 92015 |
Determination of refractive state |
64 |
64 |
$13.21 |