| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
882 |
876 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
758 |
757 |
$10K |
| V2020 |
Frames, purchases |
1,086 |
1,076 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
975 |
580 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
635 |
365 |
$2K |
| 92015 |
Determination of refractive state |
387 |
387 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
76 |
38 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
28 |
28 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
26 |
12 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
28 |
14 |
$0.00 |