| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
351 |
348 |
$31K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
951 |
840 |
$25K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
296 |
275 |
$20K |
| V2025 |
Deluxe frame |
605 |
569 |
$18K |
| 92015 |
Determination of refractive state |
1,302 |
1,235 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
83 |
82 |
$9K |
| V2020 |
Frames, purchases |
348 |
331 |
$8K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
91 |
88 |
$6K |
| V2750 |
Anti-reflective coating, per lens |
185 |
167 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
108 |
95 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
26 |
26 |
$335.66 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$300.26 |