| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,709 |
4,696 |
$832.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
114 |
114 |
$0.00 |
| V2020 |
Frames, purchases |
613 |
609 |
$0.00 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
119 |
119 |
$0.00 |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
3,152 |
3,148 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
91 |
53 |
$0.00 |
| V2599 |
Contact lens, other type |
753 |
753 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
479 |
479 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
264 |
136 |
$0.00 |
| V2521 |
Contact lens, hydrophilic, toric, or prism ballast, per lens |
99 |
99 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
312 |
154 |
$0.00 |