| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
458 |
424 |
$9K |
| V2020 |
Frames, purchases |
877 |
651 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
484 |
297 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
168 |
89 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
165 |
159 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
83 |
83 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
594 |
343 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
67 |
26 |
$368.50 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$225.00 |
| 92015 |
Determination of refractive state |
577 |
527 |
$0.00 |