| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
236 |
216 |
$9K |
| 92225 |
|
211 |
168 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
301 |
298 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
141 |
141 |
$3K |
| 92083 |
|
95 |
95 |
$2K |
| 92020 |
|
91 |
91 |
$2K |
| 92250 |
|
110 |
110 |
$2K |
| 92133 |
|
67 |
67 |
$1K |
| 92226 |
|
13 |
13 |
$580.40 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
23 |
22 |
$352.00 |
| 76514 |
|
12 |
12 |
$132.00 |
| 92015 |
Determination of refractive state |
26 |
25 |
$17.60 |
| V2020 |
Frames, purchases |
249 |
248 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
493 |
275 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
91 |
91 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
697 |
414 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
146 |
86 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
32 |
32 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
14 |
$0.00 |