| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
238 |
212 |
$9K |
| V2020 |
Frames, purchases |
554 |
536 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
521 |
505 |
$6K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
116 |
100 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
77 |
74 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
501 |
485 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$493.98 |
| 92015 |
Determination of refractive state |
214 |
210 |
$209.22 |
| V2750 |
Anti-reflective coating, per lens |
298 |
284 |
$0.00 |