| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
384 |
379 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
450 |
222 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
229 |
228 |
$9K |
| V2020 |
Frames, purchases |
781 |
774 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
276 |
138 |
$6K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
31 |
31 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
25 |
25 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
12 |
$480.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,577 |
783 |
$62.00 |
| 92015 |
Determination of refractive state |
65 |
61 |
$0.00 |