| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,284 |
2,220 |
$139K |
| V2020 |
Frames, purchases |
2,292 |
2,181 |
$55K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
597 |
584 |
$52K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
676 |
615 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
500 |
472 |
$12K |
| 92370 |
|
578 |
557 |
$8K |
| 92250 |
|
205 |
196 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
26 |
26 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
65 |
61 |
$2K |
| V2756 |
Eye glass case |
864 |
842 |
$895.39 |
| 92015 |
Determination of refractive state |
527 |
487 |
$0.00 |