| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
653 |
652 |
$62K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
664 |
663 |
$44K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
508 |
507 |
$37K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,588 |
902 |
$27K |
| V2020 |
Frames, purchases |
1,674 |
1,671 |
$21K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
333 |
331 |
$20K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
336 |
335 |
$14K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
200 |
199 |
$13K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
244 |
242 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
519 |
317 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
74 |
38 |
$13.00 |
| V2755 |
U-v lens, per lens |
52 |
26 |
$0.00 |