| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
372 |
363 |
$11K |
| V2020 |
Frames, purchases |
566 |
558 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
171 |
169 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
122 |
122 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
331 |
323 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
222 |
219 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$600.00 |
| 92015 |
Determination of refractive state |
619 |
610 |
$0.00 |