| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,825 |
3,823 |
$115K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,908 |
2,452 |
$75K |
| V2020 |
Frames, purchases |
4,916 |
4,914 |
$45K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,929 |
965 |
$26K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
266 |
133 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
216 |
216 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
39 |
39 |
$640.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
76 |
38 |
$492.96 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,224 |
1,111 |
$0.00 |