| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,216 |
1,216 |
$35K |
| V2020 |
Frames, purchases |
2,708 |
2,704 |
$27K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
784 |
784 |
$20K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,694 |
1,375 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,367 |
895 |
$8K |
| 92015 |
Determination of refractive state |
1,281 |
1,281 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
221 |
178 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
510 |
280 |
$21.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
81 |
81 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
62 |
62 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
26 |
13 |
$0.00 |