| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
638 |
638 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
543 |
543 |
$7K |
| V2020 |
Frames, purchases |
1,182 |
1,180 |
$6K |
| 92015 |
Determination of refractive state |
523 |
523 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
496 |
327 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
436 |
288 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
314 |
203 |
$754.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
306 |
195 |
$588.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
225 |
138 |
$546.00 |
| V2599 |
Contact lens, other type |
139 |
139 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
43 |
43 |
$0.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
23 |
12 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
95 |
95 |
$0.00 |