| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,325 |
1,325 |
$989.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
744 |
744 |
$430.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,596 |
863 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,452 |
782 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
205 |
205 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
45 |
24 |
$0.00 |
| V2020 |
Frames, purchases |
1,999 |
1,990 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
191 |
109 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
307 |
307 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
13 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
24 |
12 |
$0.00 |