| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
202 |
202 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
185 |
185 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
316 |
158 |
$6K |
| V2020 |
Frames, purchases |
443 |
442 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
49 |
48 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
80 |
40 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
30 |
30 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13 |
13 |
$505.62 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$448.92 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$215.11 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,052 |
525 |
$0.00 |