| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
246 |
241 |
$24K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
162 |
157 |
$19K |
| 92015 |
Determination of refractive state |
897 |
873 |
$13K |
| V2020 |
Frames, purchases |
784 |
769 |
$13K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
212 |
211 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
109 |
105 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
66 |
66 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
105 |
104 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
131 |
110 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$934.26 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
17 |
12 |
$297.81 |
| 3072F |
|
30 |
29 |
$290.00 |