| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
387 |
385 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
262 |
261 |
$816.60 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
155 |
126 |
$588.00 |
| V2020 |
Frames, purchases |
490 |
487 |
$540.00 |
| 92015 |
Determination of refractive state |
69 |
67 |
$79.20 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
91 |
62 |
$47.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
134 |
81 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
61 |
61 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
69 |
44 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$0.00 |