| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,204 |
1,164 |
$29K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
451 |
444 |
$28K |
| 92015 |
Determination of refractive state |
1,893 |
1,850 |
$26K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
407 |
401 |
$19K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
297 |
291 |
$7K |
| 92250 |
|
131 |
128 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
41 |
41 |
$4K |
| 92083 |
|
101 |
95 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
105 |
102 |
$1K |
| V2756 |
Eye glass case |
1,149 |
1,112 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
27 |
26 |
$671.15 |
| 92081 |
|
30 |
30 |
$165.91 |
| 92285 |
|
12 |
12 |
$59.25 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
26 |
26 |
$0.00 |