| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
180 |
160 |
$10K |
| V2020 |
Frames, purchases |
524 |
455 |
$10K |
| 92015 |
Determination of refractive state |
482 |
428 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
194 |
170 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
218 |
124 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
116 |
98 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
31 |
27 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
12 |
$846.12 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$565.14 |