| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
69 |
69 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
94 |
94 |
$5K |
| V2020 |
Frames, purchases |
159 |
157 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
242 |
242 |
$4K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
79 |
79 |
$4K |
| V2025 |
Deluxe frame |
99 |
99 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
151 |
151 |
$4K |
| 92250 |
|
39 |
39 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
57 |
57 |
$1K |
| 92015 |
Determination of refractive state |
78 |
78 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
16 |
$278.85 |