| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
308 |
307 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
496 |
248 |
$10K |
| V2020 |
Frames, purchases |
632 |
628 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
167 |
167 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
55 |
55 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
47 |
47 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
26 |
13 |
$534.04 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,376 |
684 |
$0.00 |