| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
989 |
989 |
$344.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
337 |
337 |
$129.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,325 |
715 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
153 |
153 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
970 |
546 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
124 |
70 |
$0.00 |
| V2020 |
Frames, purchases |
1,654 |
1,650 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
243 |
243 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
30 |
15 |
$0.00 |