| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
1,034 |
1,019 |
$28K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
787 |
778 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
63 |
63 |
$736.80 |
| 92083 |
|
36 |
34 |
$527.15 |
| 92015 |
Determination of refractive state |
381 |
377 |
$158.40 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
268 |
146 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
316 |
171 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$0.00 |
| V2020 |
Frames, purchases |
578 |
576 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
30 |
30 |
$0.00 |