| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,141 |
1,140 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
346 |
344 |
$582.00 |
| 92015 |
Determination of refractive state |
45 |
39 |
$158.40 |
| V2020 |
Frames, purchases |
1,450 |
1,433 |
$20.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
35 |
35 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
24 |
12 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
346 |
190 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,441 |
799 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
29 |
29 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$0.00 |