| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
544 |
521 |
$21K |
| 99214 |
|
154 |
153 |
$8K |
| 92083 |
|
175 |
173 |
$4K |
| 92250 |
|
185 |
183 |
$3K |
| 92133 |
|
136 |
136 |
$3K |
| 92004 |
|
1,060 |
1,050 |
$508.32 |
| V2020 |
Frames, purchases |
2,643 |
2,610 |
$344.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,756 |
1,679 |
$284.20 |
| 92014 |
|
1,114 |
1,107 |
$174.00 |
| 92015 |
|
1,846 |
1,821 |
$147.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,061 |
873 |
$90.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
386 |
230 |
$68.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
50 |
50 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
156 |
115 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
140 |
140 |
$0.00 |