| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
1,222 |
1,221 |
$30.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
618 |
618 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,382 |
1,181 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,704 |
846 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
15 |
15 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
40 |
20 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
13 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,021 |
1,017 |
$0.00 |
| V2020 |
Frames, purchases |
1,706 |
1,694 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
240 |
119 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$0.00 |