| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| T1015 |
Clinic visit/encounter, all-inclusive |
1,264 |
1,091 |
$441K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
34 |
25 |
$1K |
| V2020 |
Frames, purchases |
133 |
127 |
$995.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
438 |
391 |
$720.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
14 |
$696.31 |
| 92015 |
Determination of refractive state |
612 |
492 |
$594.19 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
687 |
587 |
$510.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
12 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
23 |
12 |
$0.00 |