| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
605 |
563 |
$31K |
| V2020 |
Frames, purchases |
451 |
419 |
$8K |
| 92015 |
Determination of refractive state |
851 |
790 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
76 |
74 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
224 |
207 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
73 |
64 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
49 |
46 |
$788.80 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
15 |
13 |
$520.88 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
31 |
14 |
$87.50 |