| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
176 |
176 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
92 |
92 |
$1K |
| 92015 |
Determination of refractive state |
105 |
105 |
$382.80 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
12 |
12 |
$160.00 |
| V2020 |
Frames, purchases |
358 |
357 |
$60.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
15 |
15 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
241 |
130 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
129 |
72 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
13 |
13 |
$0.00 |
| 2033F |
|
30 |
30 |
$0.00 |