| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
546 |
497 |
$34K |
| V2020 |
Frames, purchases |
874 |
785 |
$23K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
310 |
289 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
155 |
141 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
363 |
343 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
264 |
218 |
$4K |
| 92015 |
Determination of refractive state |
827 |
695 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
59 |
57 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
12 |
$184.26 |