| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
934 |
921 |
$85K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
559 |
555 |
$63K |
| V2025 |
Deluxe frame |
1,254 |
1,246 |
$59K |
| V2020 |
Frames, purchases |
2,059 |
2,007 |
$47K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
844 |
842 |
$41K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,278 |
1,258 |
$26K |
| 92015 |
Determination of refractive state |
1,690 |
1,671 |
$26K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
432 |
431 |
$21K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
669 |
660 |
$12K |
| 92250 |
|
210 |
209 |
$11K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
492 |
487 |
$10K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
132 |
129 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
302 |
299 |
$6K |
| V2760 |
Scratch resistant coating, per lens |
27 |
27 |
$869.51 |
| 92083 |
|
16 |
16 |
$782.24 |