| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
639 |
619 |
$63K |
| V2020 |
Frames, purchases |
2,813 |
2,652 |
$63K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
977 |
901 |
$44K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,347 |
1,278 |
$26K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
228 |
206 |
$25K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
280 |
252 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
630 |
555 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
566 |
562 |
$7K |
| 92015 |
Determination of refractive state |
149 |
147 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
29 |
29 |
$580.00 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
12 |
12 |
$288.56 |