| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
664 |
656 |
$50K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
326 |
320 |
$37K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
407 |
405 |
$17K |
| 92015 |
Determination of refractive state |
1,755 |
1,680 |
$15K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
220 |
219 |
$9K |
| V2020 |
Frames, purchases |
460 |
458 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
451 |
450 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
165 |
164 |
$3K |
| V2025 |
Deluxe frame |
78 |
78 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
58 |
58 |
$873.95 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
28 |
$345.86 |
| V2799 |
Vision item or service, miscellaneous |
17 |
16 |
$182.72 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$140.58 |
| 99072 |
|
141 |
138 |
$0.00 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
140 |
109 |
$0.00 |