| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
90 |
89 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
84 |
84 |
$8K |
| V2025 |
Deluxe frame |
127 |
127 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
189 |
146 |
$4K |
| 92015 |
Determination of refractive state |
168 |
167 |
$3K |
| V2020 |
Frames, purchases |
44 |
44 |
$831.37 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$640.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$615.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
57 |
57 |
$456.00 |