| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,222 |
2,202 |
$70K |
| V2020 |
Frames, purchases |
2,488 |
2,429 |
$26K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,821 |
1,791 |
$22K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
710 |
707 |
$20K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,239 |
1,204 |
$10K |
| 92015 |
Determination of refractive state |
2,161 |
2,141 |
$7K |
| 92227 |
|
225 |
203 |
$831.00 |
| 92250 |
|
15 |
15 |
$588.00 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
12 |
12 |
$400.00 |
| 2024F |
|
349 |
321 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
39 |
39 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
19 |
19 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
40 |
20 |
$0.00 |