| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,422 |
1,394 |
$135K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
938 |
929 |
$111K |
| V2020 |
Frames, purchases |
1,535 |
1,509 |
$45K |
| 92015 |
Determination of refractive state |
2,928 |
2,871 |
$44K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
929 |
919 |
$30K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
836 |
772 |
$20K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
186 |
186 |
$13K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
13 |
13 |
$883.72 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$324.12 |