| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
292 |
291 |
$123.44 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
890 |
884 |
$70.59 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
482 |
231 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,240 |
593 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
13 |
13 |
$0.00 |
| 92015 |
Determination of refractive state |
947 |
942 |
$0.00 |
| V2020 |
Frames, purchases |
1,045 |
1,002 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
28 |
13 |
$0.00 |