| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,738 |
1,645 |
$57K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
294 |
288 |
$28K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
162 |
158 |
$18K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
574 |
552 |
$18K |
| 92250 |
|
272 |
258 |
$15K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
204 |
201 |
$14K |
| 92015 |
Determination of refractive state |
780 |
761 |
$12K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
80 |
80 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
60 |
59 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
29 |
28 |
$1K |