| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
469 |
464 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
182 |
181 |
$3K |
| 92260 |
|
116 |
114 |
$510.00 |
| 92015 |
Determination of refractive state |
275 |
269 |
$482.90 |
| 92225 |
|
12 |
12 |
$286.84 |
| V2020 |
Frames, purchases |
705 |
696 |
$56.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
27 |
15 |
$54.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
547 |
313 |
$51.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
688 |
376 |
$20.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
26 |
26 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
77 |
63 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
56 |
56 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
224 |
122 |
$0.00 |