| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,576 |
2,569 |
$836.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,177 |
1,171 |
$674.77 |
| 92015 |
Determination of refractive state |
1,894 |
1,887 |
$92.60 |
| V2020 |
Frames, purchases |
2,862 |
2,833 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
148 |
148 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
413 |
225 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
260 |
143 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
23 |
12 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,884 |
1,234 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
909 |
520 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,008 |
1,253 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
20 |
12 |
$0.00 |