| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
163 |
149 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,852 |
3,842 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,188 |
2,184 |
$745.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,104 |
3,239 |
$30.00 |
| V2020 |
Frames, purchases |
4,625 |
4,602 |
$25.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,516 |
3,314 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
117 |
117 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
310 |
163 |
$0.00 |
| V2781 |
Progressive lens, per lens |
165 |
89 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
426 |
215 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
65 |
36 |
$0.00 |
| V2199 |
Not otherwise classified, single vision lens |
1,683 |
876 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
111 |
57 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
123 |
123 |
$0.00 |