| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
409 |
373 |
$24K |
| V2020 |
Frames, purchases |
993 |
925 |
$20K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
477 |
347 |
$19K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
155 |
84 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
73 |
73 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
58 |
55 |
$1K |
| 92015 |
Determination of refractive state |
605 |
552 |
$819.96 |