| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,097 |
1,083 |
$49K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,126 |
1,059 |
$44K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
582 |
572 |
$27K |
| V2020 |
Frames, purchases |
2,241 |
2,224 |
$24K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
482 |
238 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
806 |
495 |
$13K |
| 92250 |
|
213 |
197 |
$8K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
157 |
157 |
$6K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
55 |
55 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
32 |
15 |
$657.28 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
19 |
13 |
$342.96 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,190 |
2,117 |
$0.00 |