| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
793 |
691 |
$67K |
| V2020 |
Frames, purchases |
1,416 |
1,213 |
$37K |
| 92015 |
Determination of refractive state |
1,222 |
1,083 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
852 |
410 |
$12K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
104 |
103 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
32 |
30 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
25 |
25 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
49 |
25 |
$705.62 |