| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
618 |
614 |
$12K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
361 |
336 |
$11K |
| V2020 |
Frames, purchases |
672 |
665 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
362 |
258 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
225 |
127 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
39 |
38 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
178 |
103 |
$414.20 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$315.00 |
| 92002 |
|
21 |
21 |
$280.00 |
| 92015 |
Determination of refractive state |
107 |
91 |
$0.00 |
| V2755 |
U-v lens, per lens |
146 |
73 |
$0.00 |