| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
208 |
195 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
136 |
126 |
$9K |
| V2020 |
Frames, purchases |
300 |
285 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
293 |
277 |
$6K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
107 |
107 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
56 |
56 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
18 |
15 |
$740.27 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
76 |
73 |
$708.00 |
| 92015 |
Determination of refractive state |
17 |
16 |
$68.06 |