| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
354 |
350 |
$36K |
| 92250 |
|
255 |
254 |
$17K |
| V2020 |
Frames, purchases |
828 |
808 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
545 |
537 |
$10K |
| 92015 |
Determination of refractive state |
524 |
520 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
244 |
243 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
110 |
109 |
$5K |
| V2750 |
Anti-reflective coating, per lens |
112 |
112 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
31 |
31 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
34 |
34 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
40 |
39 |
$760.07 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
17 |
17 |
$314.45 |