| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
377 |
367 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
369 |
354 |
$10K |
| V2020 |
Frames, purchases |
604 |
581 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
475 |
459 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
260 |
250 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
40 |
40 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
24 |
24 |
$1K |
| 92015 |
Determination of refractive state |
26 |
26 |
$361.26 |