| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92060 |
|
472 |
456 |
$17K |
| 92250 |
|
212 |
211 |
$10K |
| 76512 |
|
103 |
102 |
$7K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
77 |
77 |
$6K |
| 92285 |
|
193 |
191 |
$5K |
| 92083 |
|
74 |
73 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
40 |
39 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
33 |
33 |
$2K |
| V2020 |
Frames, purchases |
181 |
178 |
$2K |
| 92132 |
|
64 |
64 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
34 |
27 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
13 |
$853.18 |
| 76514 |
|
87 |
87 |
$671.16 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
24 |
12 |
$510.24 |
| 92015 |
Determination of refractive state |
12 |
12 |
$228.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
54 |
26 |
$130.00 |
| 92286 |
|
12 |
12 |
$0.00 |