| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
349 |
348 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
194 |
192 |
$14K |
| V2025 |
Deluxe frame |
251 |
251 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
330 |
325 |
$8K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
117 |
104 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
191 |
187 |
$3K |
| V2020 |
Frames, purchases |
244 |
238 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
175 |
173 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
66 |
31 |
$952.00 |
| 92015 |
Determination of refractive state |
550 |
547 |
$30.00 |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
14 |
14 |
$0.00 |