| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,316 |
3,309 |
$74K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,397 |
2,392 |
$38K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,746 |
990 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,514 |
1,405 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
899 |
496 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
32 |
32 |
$0.00 |
| 2023F |
|
15 |
15 |
$0.00 |
| V2020 |
Frames, purchases |
3,121 |
3,043 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
15 |
15 |
$0.00 |
| 2022F |
|
15 |
15 |
$0.00 |