| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
182 |
178 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
250 |
250 |
$166.80 |
| 92015 |
Determination of refractive state |
47 |
47 |
$101.20 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
427 |
231 |
$84.00 |
| V2020 |
Frames, purchases |
316 |
314 |
$60.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
523 |
280 |
$44.84 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
35 |
35 |
$0.00 |