| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,069 |
975 |
$31K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,039 |
951 |
$22K |
| V2020 |
Frames, purchases |
1,277 |
1,175 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
355 |
329 |
$10K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
245 |
232 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
484 |
446 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
34 |
34 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
16 |
15 |
$91.00 |