| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
363 |
322 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
438 |
403 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
126 |
99 |
$5K |
| V2020 |
Frames, purchases |
286 |
268 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
16 |
$148.61 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
29 |
28 |
$78.00 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
35 |
35 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
20 |
20 |
$0.00 |