| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,925 |
2,920 |
$26K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
414 |
414 |
$4K |
| 92015 |
Determination of refractive state |
710 |
708 |
$1K |
| V2020 |
Frames, purchases |
2,883 |
2,744 |
$472.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,009 |
997 |
$221.60 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,682 |
832 |
$102.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,298 |
1,169 |
$87.40 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
160 |
86 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
156 |
156 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
110 |
54 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
45 |
45 |
$0.00 |