| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
266 |
266 |
$11K |
| V2020 |
Frames, purchases |
812 |
791 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
399 |
195 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
128 |
126 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
122 |
61 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
31 |
31 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,187 |
572 |
$80.00 |
| 92015 |
Determination of refractive state |
73 |
72 |
$0.00 |