| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,191 |
2,186 |
$22.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,601 |
850 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
334 |
334 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
33 |
33 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
30 |
15 |
$0.00 |
| V2020 |
Frames, purchases |
2,051 |
2,045 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
12 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
84 |
84 |
$0.00 |