| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99203 |
|
421 |
417 |
$25K |
| 99215 |
Prolong outpt/office vis |
276 |
275 |
$20K |
| 92250 |
|
277 |
276 |
$9K |
| 92004 |
|
1,336 |
1,326 |
$9K |
| 99213 |
|
234 |
232 |
$6K |
| 92014 |
|
1,368 |
1,358 |
$6K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
80 |
79 |
$4K |
| 92134 |
|
77 |
77 |
$2K |
| V2020 |
Frames, purchases |
2,441 |
2,407 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,013 |
1,043 |
$903.00 |
| 99205 |
Prolong outpt/office vis |
16 |
16 |
$516.80 |
| 99204 |
|
15 |
15 |
$484.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,641 |
843 |
$37.62 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
103 |
52 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
968 |
504 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
111 |
55 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
92 |
92 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
106 |
53 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
59 |
59 |
$0.00 |