| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
236 |
234 |
$1K |
| V2020 |
Frames, purchases |
221 |
217 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
34 |
34 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
132 |
69 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
30 |
15 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
19 |
19 |
$0.00 |