| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,379 |
2,354 |
$25K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,224 |
1,217 |
$19K |
| 92015 |
Determination of refractive state |
1,880 |
1,857 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
151 |
146 |
$3K |
| V2020 |
Frames, purchases |
2,483 |
2,244 |
$360.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,660 |
1,222 |
$273.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,631 |
776 |
$269.80 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
750 |
356 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
16 |
16 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
1,316 |
639 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
70 |
70 |
$0.00 |