| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
498 |
456 |
$13K |
| V2020 |
Frames, purchases |
812 |
614 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
209 |
171 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
66 |
61 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
109 |
80 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
190 |
132 |
$936.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
13 |
13 |
$650.00 |
| 92015 |
Determination of refractive state |
495 |
435 |
$0.00 |