| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
789 |
755 |
$31K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
877 |
860 |
$28K |
| V2025 |
Deluxe frame |
566 |
550 |
$22K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
419 |
391 |
$17K |
| V2020 |
Frames, purchases |
131 |
130 |
$2K |
| 92015 |
Determination of refractive state |
483 |
446 |
$906.54 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
16 |
16 |
$740.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
503 |
489 |
$584.24 |
| 99199 |
Unlisted special service, procedure or report |
38 |
38 |
$0.00 |