| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
585 |
534 |
$42K |
| V2020 |
Frames, purchases |
714 |
677 |
$15K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
266 |
157 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
69 |
68 |
$8K |
| 92015 |
Determination of refractive state |
807 |
733 |
$6K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
70 |
57 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
62 |
61 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
50 |
48 |
$753.32 |