| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
725 |
614 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
798 |
775 |
$15K |
| V2020 |
Frames, purchases |
1,041 |
1,009 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
378 |
336 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
520 |
508 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
122 |
110 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
17 |
17 |
$850.00 |
| 92015 |
Determination of refractive state |
55 |
44 |
$703.74 |
| 3072F |
|
69 |
57 |
$0.00 |