| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
25 |
25 |
$3K |
| V2020 |
Frames, purchases |
70 |
69 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
50 |
49 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
27 |
27 |
$895.46 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
13 |
13 |
$866.32 |
| 92015 |
Determination of refractive state |
51 |
51 |
$794.17 |