| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,188 |
911 |
$53K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
903 |
758 |
$47K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
582 |
580 |
$25K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
216 |
213 |
$9K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
211 |
205 |
$9K |
| 92015 |
Determination of refractive state |
461 |
458 |
$7K |
| V2025 |
Deluxe frame |
560 |
446 |
$6K |
| V2020 |
Frames, purchases |
138 |
138 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
20 |
14 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
113 |
113 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
29 |
29 |
$319.00 |