| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
326 |
320 |
$32K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
216 |
215 |
$17K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
163 |
158 |
$7K |
| 92015 |
Determination of refractive state |
598 |
581 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
38 |
34 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
34 |
26 |
$3K |
| 92133 |
|
85 |
84 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
26 |
19 |
$1K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
28 |
26 |
$1K |
| 92082 |
|
32 |
32 |
$836.99 |
| V2750 |
Anti-reflective coating, per lens |
16 |
13 |
$0.00 |
| V2020 |
Frames, purchases |
41 |
41 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
41 |
41 |
$0.00 |
| 2023F |
|
59 |
59 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
15 |
$0.00 |